U.  S.  DEPARTMENT  OF  AGRICULTURE, 

BUREAU  OF  ANIMAL  INDUSTRY— BULLETIN  NO.  53. 
D.  E.  SALMON,  D.  V.  M.,  Chief  of  Bureau. 


REPORTS 


ON 


BOVINE  TUBERCULOSIS  AND  PUBLIC  HEALTH. 


BY 


D.  E.  SALMON,  D.  V.  M., 

Chairman  of  the  Committee  on  Animal  Diseases  and  Animal  Food 
of  the  American  Public  Health  Association. 


WASHINGTON: 

GOVERNMENT     1'RINTING     O'FFICE. 
1904. 


ORGANIZATION  OF  THE  BUREAU  OF  ANIMAL  INDUSTRY. 


Chief:  D.  E.  SALMON,  T).  V.  M. 
Assistant  chief:  A.  D.  MELVIN,  D.  V.  S. 
Chief  clerk:  E.  B.  JONES,  LL.  M.,  M.  D. 

Dairy  Division:  HENRY  E.  ALVOKD,  C.  E.,  chief;  CLARENCE  B.  LANE,  B.  S.,  assistant 
chief. 

Inspection  Dirix'io n :  \.  M.  FARRINGTON,  B.  S.,  D.  V.  M.,  chief. 
Quarantine  Division:  RICHARD  W.  HICKMAN,  Ph.  G.,  V.  M.  D.,  chief. 
Wilor:  GEORGE  FAYETTE  THOMPSON,  M.  S. 
Artist:  W.  S.  D.  HAINES. 

Expert  in  Animal  Husbandry:  GEORGE  M.  ROMMEL,  B.  S.  A. 
Librarian:  BEATRICE  C.  OBERLY. 


LABORATORIES. 

Biochemic  Division:  E.  A.  DE  SCHWEINITZ,  Ph.  D.,  M.  D.,  chief;  MARION  DORSET 
M.  D.,  assistant  chief. 

Pathological  Division:  JOHN  R.  MOHLER,  A.  M.,  V.  M.  D.,  chief;  HENRY  J.  WASH- 
BURN,  D.  V.  S.,  acting  assistant  chief. 

Zoological  Division:  CH.  WARDELL  STILES, a  M.  8.,  A.  M.,  Ph.  D.,  consulting  zoologist 
in  charge. 

EXPERIMENT   STATION. 

Superintendent:  E.  C.  SCHROEDER,  M.  I).  V.;  expert  assistant,  W.  E.  COTTON. 

INSPECTORS   IN,   CHARGE. 


Dr.  F.  W.  Ainsworth,  Union  Stock  Yards,  Pitts- 
burg,  Pa. 

Dr.  M.  O.  Anderson,  care  Geo.  A.  Hormel  &  Co., 
Austin,  Minn. 

Dr.  Don  C.  Ayer,    Post-Office   Building,   South 
Omaha,  Nebr. 

Dr.  John  A.  Bell.  Watertown,  N.  Y. 

Dr.  G.  S.  Baker,  cth  and  Townsend  sts.,  San  Fran- 
cisco, ('ill. 

Dr.  L.  R.  Baker,  South  St  Joseph,  Mo. 

Dr.  Boyd  Baldwin,  care  Cudahv  Bros.,  Cudahv 
Wis. 

Dr.  A.  E.  Behnke,  room  432,  Federal  Building 
Milwaukee,  Wis. 

Dr.  J.  A.  Bell,  Watertown.  N.  Y. 

Dr.  S.  E.  Bennett.  147  Milk  st.,  Boston  Mass 

Dr.  Eli  L.  Bertram,  Tri-City  Packing  Co.,  Daven- 
port, Iowa. 

Dr.  Richard  J.  Blanche,  care  Brittain  &  Co.,  Mar- 
shal I  town.  Iowa. 

Dr.  Fred  Braginton,  care  Continental  Packing  Co 
Bloomington,  111. 

Dr.  J.  J.  Brougham,  care  Missouri  Stock  Yards 
St.  Louis,  Mo. 

Dr    G.  W.  Butler,  care  Drummond  Bros.,  Eau 
Claire,  Wis. 

Dr.  .T.  K.  Clancy.  National  Stock  Yards,  III 

Dr.  Charles  Cowie,  Ogdensburg.  X.  V 

Dr.  David  Gumming,  912  Lapeer  ave.,  Port  Huron 
Mich. 

Dr.   Robert  Darling,  care  Chas.  S.   Hardy    San 
Diego,  Cal. 

Dr.  J.  F.  Deadman,  Sault  Stc.  Marie,  Mich 

Mr.  Albert  Dean,  room  328,  Stock  Yard  Station 

Kansas  City,  Kans. 
Dr.  F.  L.  De  Wolf,  care  Chas.  Wolff  Packing  Co 

Topeka,  Kans. 

Dr  Geo.  Ditewig,  -Union  Stock  Yards,  Cincinnati 
Ohio. 


Dr.  F.  P.  Dolan,  Richmond,  Va. 

Dr.  E.  P.  Dowd,  care  White,  Pevev  &  Dexter  Co 

Worcester,  Mass. 
Dr.  O.  E.  Dyson.  316  Exchange  Building,  Union 

Stock  Yards,  Chicago,  111. 
Dr.  Geo.  C.  Faville,  Box  7%,  Norfolk,  Va 
Dr    N.  K.  Fegley,  care  Sperry  &  Barnes,  New 

Haven,  Conn. 

Dr.  T.  A.  Geddes,  care  U.  S.  consul,  London,  Eng- 
land. 

Dr.  H.  H.  George,  507  Johnson  st.,  Louisville  Ky 
Dr.  W.  H.  Gibbs,  care  Morton-Gregson  Co.  Xe- 

braska  City,  Nebr. 
Dr.  L.  K.  Green,  care  Hammond,  Standish  &  Co., 

Detroit,  Mich. 

Dr.  H.  A.  Hedrick,  215  St.  Paul  st.,  Baltimore,  Md 
Dr.  O.  B.  Hess,  care  Frye-Bruhn  Co.,  Seattle  Wash 
Mr.  G.  S.  Hickox,  P.  O.  box  1145,  Salt  Lake  (-Jtv! 

Utah. 

Dr.  A.  A.  Holcomb,  Aurora,  111. 
Dr.  Julius  Huelsen,  care  The  Jersey  City  Stock 

Yards  Co.,  Jersey  City,  N.  J. 
Dr.  F.W.  Huntington,  No.  1  India  st,  Portland,  Me 
Dr.  G.  A.  Johnson,  Exchange    Building,   Sioux 

City,  Iowa. 
Dr.  Charles  Keane,  care  Cudahy  Packing  Co. 

Los  Angeles,  Cal. 
Dr.  J.  S.  Kelly,  care   Blomer   &   Michael  Co. 

Quincy,  111. 

Dr.  F.  D.  Ketchum,  South  St.  Paul,  Minn. 
Dr.  W.  B.  Lincoln,  Union  Stock  Yards,  Nashville 

Tenn. 
Dr.  C.  Loveberry,  Room  402  Custom-House  (new) 

Portland,  Oreg. 

Dr.  H.  D.  Mayne,  Malone,  N.  Y. 
Dr.  J.  Miller,  care  John  Morrell  &  Co.,  Ottumwa 

Iowa. 
Dr.  J.  C.  Milnes,  care  The  Rath  Packing  Co., 

Waterloo,  Iowa. 


(Continued  on  third  page  of  cover.) 


'  J6'  190!?.  to  the  U.  S.  Public  Health  and  Marine  Hospital  Service,  as  Chief  of 
Indutry  y'  but  remains  also  in  temporary  charge  of  Zoological  Division,  Bureau  of  Animal 


U.  S.  DEPARTMENT  OF  AGRICULTURE, 

BUREAU  OF  ANIMAL  INDUSTRY— BULLETIN  NO.  53. 

D.   E.  SALMON,   D.  V.  M.,  Chief  of  Bureau. 


REPORTS 


ON 


BOVINE  TUBERCULOSIS  AND  PUBLIC  HEALTH. 


BY 


D.  E.  SALMON,  D.  V.  M., 

Chairman  of  the  Committee  on  Animal  Diseases  and  Animal  Food 
of  (he  American  Public  Health  Association. 


WASHINGTON: 

GOVKRXMKXT     I'RlNTIN'c;     ( )  K  1-  I  C  K  . 
1904. 


LETTER  OF  TRAXSMITTAL 


U.  S.  DEPARTMENT  OF  AGRICULTURE, 

BUREAU  OF  ANIMAL  INDUSTRY, 
Washington,  D.  C.,  November  21,  1903. 

SIR:  I  have  the  honor  to  transmit  herewith  a  manuscript  entitled 
';  Reports  on  Bovine  Tuberculosis  and  Public  Health,"  and  recommend 
that  it  be  published  as  Bulletin  No.  53  of  the  Bureau  series.  The 
subject-matter  of  this  manuscript  is  the  annual  reports  on  the  relation- 
ship between  bovine  and  human  tuberculosis  made  to  the  American 
Public  Health  Association  for  the  years  1901,  1902,  and  1903  by  me 
as  chairman  of  the  committee  on  animal  diseases  and  animal  food,  a 
position  which  I  have  held  during'  these  years. 

The  first  of  these  reports  was  published  as  Bulletin  No.  33  of  this 
Bureau,  but  the  supply  is  about  exhausted.     It  is  included  herewith 
because  of  the  demand  for  all  three  reports  from  a  class  of  people  who 
will  make  the  best  possible  use  of  the  information  given. 
Respectfully, 

D.  E.  SALMON, 

Chief  of  Bureau. 
Hon.  JAMES  WILSON, 

Secretary. 


CONTEXTS. 


Page. 

Introduction 5 

Bovine  tuberculosis  affecting  the  public  health.     (First  report) 6 

Extent  of  bovine  tuberculosis 6 

Effect  of  products  of  diseased  animals  on  public  health 8 

The  communicability  of  bovine  tuberculosis  to  man 8 

Accidental  inoculations  of  man  with  bovine  bacilli 13 

Tuberculosis  in  man  believed  to  have  been  caused  by  ingestion  of  milk 

from  tuberculous  cows 16 

Statistics  showing  frequency  of  abdominal  tuberculosis 19 

Postmortem  examinations  showing  intestinal  tuberculosis 26 

Bovine  tuberculosis  affecting  the  public  health.      (Second  report) 33 

Recent  researches  with  reference  to  the  communicability  of  human  tuber- 
culosis to  animals 35 

The  transmission  of  bovine  tuberculosis  to  man 44 

Investigations  bearing  upon  intestinal  infection 47 

Bovine  tuberculosis  affecting  the  public  health.     (Third  report) 51 

Bibliography .0 


BOVINE  TUBERCULOSIS  AND  PUBLIC  HEALTH. 


INTRODUCTION. 

Owing  to  the  interest  manifested  in  recent  years  in  the  subject  of 
bovine  tuberculosis,  and  particularly  in  the  danger  of  its  being  com- 
municated to  mankind,  it  devolved  upon  the  writer,  as  chairman  of  the 
committee  on  animal  diseases  and  animal  food  of  the  American  Public 
Health  Association,  to  prepare  and  submit  reports  covering  the  essential 
points  of  this  subject  and  presenting  the  most  striking  evidence  in  his 
possession.  These  reports  are  published  herewith.  The  more  impor- 
tant points  embraced  in  the  discussion  are  as  follows: 

(1)  Extent  of  bovine  tuberculosis  in  Europe  and  the  United  States. 

(2)  Effect  of  products  of  diseased  animals  upon  the  health  of  con- 
sumers, without  reference  to  the  direct  transmission  of  a  contagious 
disease. 

(3)  The  accidental  infection  of  man  by  inoculation  with  bovine  bacilli. 

(4)  The  infection  of  man  by  consuming  the  milk  of  tuberculous  cows. 

(5)  The  results  of  scientific  experiments  with  regard  to  the  trans- 
mission of  tuberculosis  from  man  to  bovine  animals  and  vice  versa. 

The  results  of  recent  experiments,  both  in  Europe  and  in  the  United 
States,  demonstrate  that  quite  frequently  tuberculosis  bacilli  are  found 
in  the  human  subject  which  are  virulent  for  bovine  animals.  It  must 
be  admitted,  therefore,  that  either  the  human  bacillus  under  certain 
conditions  takes  on  an  unusual  virulence  and  is  then  practically  iden- 
tical with  the  bovine  bacillus,  or  that  these  especially  active  bacilli 
have  originated  in  cattle  and  caused  disease  in  man.  In  either  case  the 
arguments  which  have  been  particularly  urged  during  the  last  few 
years  against  the  danger  from  bovine  tuberculosis  are  shown  to  be 
weak  and  out  of  harmony  with  clearly  established  facts. 

The  development  of  our  knowledge  concerning  this  question  has 
been  rapid,  and  the  facts  brought  together  in  these  reports  will  give 
those  interested  in  the  subject  a  fairly  clear  idea  of  its  present  status. 

1).  E.  SALMON. 
5 


BOVINE   TUBERCULOSIS   AFFECTING    THE    PUBLIC 
HEALTH.    (First  report.)" 

By  D.  E.  SALMON,  D.  V.  M., 

f'hief  of  llu'  Bureau  of  Animal  Industry  ami  Chairman  of  the  Committee  on  Animal 
]>!sea#eit  and  Animal  Food  of  the  American  Public  Health  Association. 

Your  committee  on  animal  diseases  and  animal  food  has  been 
impressed  with  the  importance  of  the  discussions  which  occurred  at 
the  recent  British  Congress  on  Tuberculosis  concerning  bovine  tuber- 
culosis and  its  effects  upon  the  public  health.  Some  of  the  opinions 
expressed  at  that  congress  have  aroused  the  most  extended  interest 
among  physicians  and  among  laymen,  and  it  seems  appropriate  that 
your  committee  should  at  this  time  review  the  subject  at  some  length, 
in  order  to  make  clear  what  is  already  known,  preparatory  to  taking 
steps  definitely  to  settle  contested  questions  by  experimentation. 

EXTENT   OF   BOVINE    TUBERCULOSIS. 

The  extent  and  rapid  increase  of  bovine  tuberculosis  in  various 
countries  has  during  recent  years  caused  alarm,  both  because  of  its 
effects  in  reducing  the  general  food  supphT  and  its  supposed  danger  to 
human  health. 

The  slaughterhouse  statistics  of  Prussia  show  14.6  per  cent  of  the 
cattle  and  2.14  per  cent  of  the  hogs  to  be  tuberculous.  In  Saxony 
the  percentage  is  29.13  for  cattle  and  3.10  for  hogs.  In  the  city  of 
Leipzig  the  figures  are  36.4  for  cattle  and  2. IT  for  hogs.  (Siedam- 
grotzky.)  Of  20,850  animals  in  Belgium  tested  with  tuberculin  in 
1896,  48.88  per  cent  reacted.  (Stubbe.)  Of  25,439  tested  in  Denmark 
from  1893  to  1895,  49.3  per  cent  reacted;  and  of  67,263  tested  from 
1896  to  1898,  32.8  per  cent  reacted.  (Bang.)  An  examination  of 
20,930  cattle  in  Great  Britain,  either  slaughtered  and  examined  post- 
mortem or  tested  with  tuberculin,  showed  5,441,  or  26  per  cent,  affected 
with  tuberculosis.  McFadyean  estimates  that  30  per  cent  of  the  cows 
in  Great  Britain  are  tuberculous. 

Figures  available  in  the  United  States  do  not  cover  a  sufficient  area 
of  our  territory  to  allow  us  to  make  a  reliable  estimate  of  the  extent 
of  tuberculosis  with  milch  cows.  There  is  little  doubt,  however,  but 
that  the  disease  has  been  increasing  both  with  dairy  cattle  and  hogs. 

«  Report  of  committee  on  animal  diseases  and  animal  food  to  the  American  Public 
Health  Association,  at  Buffalo,  X.  Y.,  September  16-20,  1901.     Published  also  as 
Bulletin  Xo.  33  of  the  Bureau  of  Animal  Industry. 
6 


BOVINE    TUBEKCULOSIS    AND    PUBLIC    HEALTH. 


From  a  recent  review  by  Russell  and  Hastings,  of  the  Wisconsin  Agri- 
cultural Experiment  Station,  of  tests  of  cattle  for  tuberculosis  which 
have  been  made  in  the  United  States,  the  following  summary  is  pre- 
sented:1" 

Statistics  of  tt'xts  for  tuberculosis  in  the  United  States. 


Number 

Number 

Per  cent 

State. 

tested. 

tubercular. 

tubercular. 

Vermont  

CO,  000 

2,390 

3.9 

Massachusetts  

24,685 

12,443 

50.0 

Massachusetts,  entire  herds  

4,093 

1,080 

20.  4 

Connecticut  

6,300 

14.2 

New  York,  1894  

947 

GO 

C,.  9 

New  York,  1897  98  

1,200 

1(13 

IS.  4 

Pennsylvania  

34,000 

4,800 

14.1 

New  Jersey  

2,  500 

21.  I 

Illinois,  1897-98  

929 

12.0 

Illinois,  1899  

3,  655 

560 

15.32 

Michigan  

13.0 

Minnesota  

'            3,430 

11.1 

Iowa  •  

873 

122 

13.  8 

Wisconsin: 

Experiment  station  tests  — 

Suspected  herds  

323 

115 

35.  f> 

Nonsuspeeted  herds  

935 

84 

9.0 

Suspected  herds 

Tests  of  local  veterinarians  under  State  veterinarian  (cattle 
intended  for  shipment  to  States  requiring  tuberculin  cer- 
tificate)   


588 


The  State  veterinarian  of  Pennsylvania,  Dr.  Pearson,  thinks  that 
not  over  '2  per  cent  of  the  cattle  of  that  State  are  tuberculous,  and 
probably  if  a  general  test  of  all  the  cattle  of  the  other  States  mentioned 
were  made  we  should  tind  a  very  much  smaller  proportion  tubercu- 
lous than  is  indicated  by  this  tabular  statement.  The  explanation  of 
the  high  percentages  that  have  been  given  is  found  in  the  fact  that  it 
has  been  for  the  most  part  suspected  herds  which  have  been  tested. 
Admitting  that  the  greater  part  of  these  percentages  are  too  high, 
they  are  still  sufficient  to  demonstrate  the  wide  distribution  of  tuber- 
culosis and  its  comparative  frequency. 

Our  h<-ef  cattle,  as  they  come  to  the  large  packing  houses,  are  yet 
comparatively  free  from  tuberculosis.  Of  4,841,16(5  cattle  slaughtered 
in  the  year  i!»oo  under  Federal  inspection,  but  5,27!*,  or  0.11  per  cent, 
were  sufficiently  affected  to  cause  the  condemnation  of  any  part  of  the 
carcass.  Of  U3,33t».SM4  hogs  similarly  inspected,  5,440  were  sufficiently 
affected  to  cause  condemnation  of  some  part  of  the  carcass.  This  is 
equal  to  <U>:W  per  cent,  or  slightly  more  than  one-fifth  the  proportion 
found  in  Ix-ef  cattle. 


an-  to  bibliography  sit  i-ml  of  bulletin. 


8  BUREAU  OF  ANIMAL  INDUSTRY. 

The  slaughterhouse  statistics  of  all  countries  show  that  the  percent- 
age of  affected  hogs  increases  as  the  disease  becomes  more  common  in 
cattle,  so  that  we  must  consider  not  only  the  effect  of  the  disease  upon 
beef  and  milk  producing  animals,  but  also  upon  hogs.  The  disease  is 
more  acute  with  hogs  than  with  cattle,  and  there  is  a  much  greater 
tendency  to  generalization,  and  consequently  the  parts  used  for  human 
food  are  more  likely  to  be  affected;  and  if  there  is  a  possibility  of 
communicating  the  disease  through  the  meat  the  danger  is  increased 
by  this  peculiarity  of  these  animals. 

EFFECT   OF    PRODUCTS   OF    DISEASED    ANIMALS   ON   PUBLIC    HEALTH. 

Admitting,  as  we  must,  the  increase  of  this  disease  among  our  food- 
producing  animals,  particularly  cattle  and  hogs,  it  appeal's  that  this 
fact  should  cause  concern  from  a  public  health  standpoint  irrespective 
of  the  question  of  the  direct  communicability  of  tuberculosis  from 
animals  to  man.  The  people  of  the  United  States  have  always 
demanded  meat  from  animals  which  were  free  from  disease.  Animal 
food  has  been  so  abundant  and  so  cheap  that  even  the  poorer  classes 
of  our  population  have  been  able  to  use  the  best.  There  is  110  reason 
apparent  at  this  time  why  there  should  be  a  departure  from  this  rule 
and  the}'  be  expected  to  consume  the  products  of  animals  affected  writh 
tuberculosis.  Animals  so  affected  often  have  mixed  infection,  with  high 
temperature,  the  formation  of  pus  in  different  parts  of  the  body,  and 
particularly  in  the  mammary  glands,  and  there  is  undoubtedly  in  many 
cases  a  considerable  development  of  toxins.  The  flesh  of  such  animals 
must  be  affected  in  the  same  way  as  is  that  of  animals  affected  with  other 
fevers  and  septic  conditions.  The  extensive  development  of  tubercular 
lesions  in  the  udder  affects  the  secretion  of  milk,  changes  its  composi- 
tion, causes  the  secretion  of  great  quantities  of  pus  which  are  mixed 
with  the  milk,  and  leads  to  the  development  of  a  great  variety  of 
saproph  vtic  germs  which  multiply  in  the  milk  and  develop  various 
decomposition  products. 

The  consumption  of  food  of  this  character  has  always  been  consi'd- 
ered  harmful,  and  especially  so  to  children.  It  may  seriously  affect 
the  digestion  and  cause  diarrhea  and  other  forms  of  illness  by  the  toxins 
which  are  taken.  It  is  extremely  desirable  that  the  source  of  our 
food  supply  should  be  guarded  from  contamination  by  disease  and 
kept  in  as  nearly  a  normal  and  health}'  condition  as  possible.  Every 
departure  from  this  ideal  state  is  a  menace  to  the  consumer  and  an 
injury  to  the  public  at  large. 

THE   COMMUNICABILITY    OF   BOVINE   TUBERCULOSIS   TO    MAN. 

The  important  question  as  to  whether  bovine  tuberculosis  can  be 
directly  communicated  to  man  has  attracted  considerable  attention  in 
this  country  for  several  years,  and  was  discussed  by  the  committee  on 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  *> 

animal  diseases  and  animal  food  at  the  last  meeting.  The  conclusion 
had  already  been  reached  by  some  writers  in  this  country  that  mankind 
was  not  susceptible  to  the  form  of  tuberculosis  which  affects  cattle. 
Now  that  this  conclusion  has  been  accepted  and  promulgated  by  Koch2 
in  his  address  at  the  British  Congress  on  Tuberculosis,  and  has  been 
received  so  seriously  by  people  generally  as  well  as  by  the  medical 
profession,  it  is  deemed  desirable  to  recapitulate  what  was  said  at  that 
time  and  to  add  such  further  evidence  and  arguments  as  are  available. 

In  this  discussion  we  should  never  lose  sight  of  the  fact  that,  even 
if  Koch's  position  is  correct  as  to  the  insusceptibility  of  mankind  to 
bovine  tuberculosis — a  conclusion  which  your  committee  believes  is 
unwarranted  by  the  evidence — and  if  it  is  admitted  that  it  is  unneces- 
sary to  adopt  measures  against  the  bovine  disease  in  the  tight  against 
human  tuberculosis,  it  does  not  follow,  by  any  means,  that  the  prod- 
ucts of  these  diseased  animals  are  harmless  and  should  be  allowed  to 
go  into  consumption.  Nevertheless,  Koch's  conclusion  is  being  used 
already  as  an  argument  and  excuse  for  the  sale  of  tuberculous  meat 
and  milk.  This  discussion  as  to  the  communicability  of  bovine  tuber- 
culosis should  not  be  allowed  to  obscure  the  general  question  of  the 
importance  of  condemning  meat  and  milk  of  diseased  animals,  whether 
the  disease  is  or  is  not  a  specific  one  which  may  be  communicated  to 
the  consumer  of  these  products.  There  is  no  argument  to  justify  the 
sale  of  milk  secreted  by  tuberculous  udders,  reeking  with  pus  and 
the  microorganisms  which  it  contains,  changed  in  its  chemical  compo- 
sition, and  unsavory  to  every  civilized  person.  The  question  of  the 
desirability  of  measures  against  bovine  tuberculosis  as  a  part  of  the 
campaign  against  human  tuberculosis  is  a  thing  by  itself  and  entirely 
distinct  from  the  desirability  of  such  measures  from  an  economic  and 
general  public-health  standpoint. 

Whenever  this  question  is  discussed  in  medical  meetings  or  medical 
journals  the  general  excuse  for  a  toleration  of  the  present  condition  of 
affairs  is  that  the  danger  from  bovine  tuberculosis  has  been  greatly 
exaggerated.  Quite  likely  it  has  been  exaggerated  by  some  individ- 
uals, but  it  has  just  as  certainly  been  underestimated  by  others.  What 
has  been  the  effect  of  the  discussions  heretofore  held  (  Have  the 
public  been  too  much  alarmed?  Have  sanitarians  gone  to  too  great 
extremes?  Have  we  anywhere  a  too  rigid  meat  inspection  or  a  too 
careful  supervision  of  the  milk  supply?  If  so.  your  committee  is  not 
aware  of  the  fact.  And,  until  this  occurs,  the  repetition  of  the  state- 
ment that  the  danger  from  bovine  tuberculosis  has  been  exaggerated 
a]) pears  to  be  entirely  superfluous  and  useless. 

Koch  in  his  recent  paper  makes  two  radical  assumptions:  First, 
human  tuberculosis  differs  from  bovine  tuberculosis,  and  can  not  be 
communicated  to  cattle;  second,  mankind  is  nearly,  if  not  absolutelv, 
insusceptible  to  bovine  tuberculosis.  It  is  incumbent  upon  us  to 


10  MIKEAU    OF    ANIMAL    INDUSTRY. 

examine  the  evidence  upon  which  these  propositions  rest,  for  if  they 
can  be  demonstrated  the  fact  would  be  welcomed  by  every  sanitarian, 
not  because  it  would  no  longer  be  necessary,  for  economic  and  public 
health  reasons,  to  control  bovine  tuberculosis,  but  because  it  would 
prove  that  some  dangers  which  we  have  hitherto  feared  do  not  exist, 
and  it  would  simplify  the  measures  needed  in  the  warfare  against 
human  tuberculosis.  We  should  not  allow  ourselves,  therefore,  to  be 
biased  by  preconceived  opinions,  but  should  honestly  and  conscien- 
tiously weigh  all  evidence  that  is  presented. 

Neither  of  these  propositions  is  original  with  Koch,  but  this  is  prob- 
ably the  first  time  that  a  scientific  man  of  such  standing  and  authority 
has  ventured  to  adopt  them.  Sidney  Martin,  in  his  experiments  for  the 
British  Koyal  Tuberculosis  Commission  of  1895,  showed  that  sputum 
from  man  was  far  less  virulent  for  animals  than  was  bovine  tubercular 
material.  Theobald  Smith,  Frothingham,  and  Dinwiddie  have  repeated 
these  experiments  with  cattle  and  other  animals  and  incontestably 
demonstrated  this  conclusion.  It  does  not  appear  to  be  entirely  cor- 
rect, however,  to  say  that  human  tuberculosis  is  not  communicable  to 
cattle.  It  would  be  more  accurate  to  say  that  in  the  experiments 
referred  to  human  tuberculosis  wTas  only  communicated  with  difficulty 
to  cattle,  and  when  it  was  communicated  it  remained  localized  and  did 
not  cause  a  fatal  disease. 

Of  0  calves  to  which  sputum  was  fed  by  Martin,  2  showed  no  lesions, 
1  had  53,  1  had  63,  and  2  had  13  tubercular  nodules,  respectively,  in 
the  intestines.  In  1  of  these  animals  the  mesenteric  glands  were  also 
affected.  Smith  also  produced  small  lesions  in  some  of  the  animals 
with  which  he  experimented.  The  failure  to  cause  fatal  disease  in 
cattle  with  sputum  bacilli  appears  to  be  due  to  lack  of  virulence,  or, 
we  might  say,  to  low  pathogenic  power,  rather  than  to  any  essential 
difference  in  bacilli  from  human  and  bovine  sources.  This  is  shown  by 
the  fact  that  human  bacilli  were  less  active,  not  only  when  inoculated 
upon  cattle,  but  also  when  inoculated  upon  other  species  of  animals. 

The  experiments  of  Chauveau,3  which  were  made  prior  to  those  men- 
tioned above,  are  more  conclusive  and  can  not  be  ignored  in  discussing 
this  question.  In  one  series  of  experiments  he  infected  2  heifers  and 
a  bull,  all  under  1  year  old,  with  emulsions  made  from  tuberculous 
human  lungs.  These  infections  were  by  ingestion,  but  two  doses  being 
given  to  each  animal.  One  of  the  heifers,  killed  57  days  after  infection, 
had  more  than  200  tubercles  of  different  sizes  in  the  small  intestines. 
There  were  also  tubercles  in  the  cecum,  colon,  abomasum,  liver,  and 
peritoneum.  The  autopsy  on  the  second  heifer  occurred  59  days  after 
infection.  In  this  case  the  abdominal  lesions  were  insignificant,  con- 
sisting of  two  or  three  follicular  hypertrophies  in  the  jejunum  and  a 
few  small  tubercular  mesenteric  glands.  The  right  submaxillary  gland 
and  the  two  retropharyngeal  glands  were  enlarged  and  affected  with 


f 
BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  11 

typical  tubercular  infiltration.  The  lungs  showed  not  less  than  12 
tuberculous  centers,  most  of  them  the  size  of  a  walnut,  and  near  these 
masses  were  points  where  tubercular  infiltration  was  beginning.  All 
the  bronchial  and  mediastinal  glands  were  enlarged,  tuberculous,  and 
infiltrated  with  gray  and  yellow  matter.  The  bull  was  destroyed  on 
the  thirty-fourth  day.  There  was  a  plain  tuberculous  eruption  in  the 
small  intestine,  some  portions  of  the  mucous  membrane,  particularly 
on  the  Peyer's  patches,  being  covered  with  confluent  tubercles.  In  the 
left  lung  there  was  a  single  tuberculous  nodule  of  considerable  size, 
and  some  lobules  presented  a  gelatinous  appearance  and  consistency. 
There  were  aggregations  of  small  tubercles  in  the  larynx  and  upper 
part  of  the  trachea,  some  of  which  were  already  ulcerated.  There 
were  also  tubercular  granulations  in  the  bronchi.  At  the  time  these 
animals  were  infected,  3  similar  animals  were  infected  in  like  manner 
with  bovine  material,  and  3  others  were  held  as  checks.  The  latter 
were  found  free  from  tuberculosis.  At  the  autopsy  it  was  impossible 
to  distinguish  any  difference  between  the  animals  infected  with  human 
and  those  with  bovine  material.  All  were  affected,  and  with  all  the 
tuberculous  lesions  had  the  same  characters. 

Chauveau,  also,  made  comparative  experiments  by  intravenous  injec- 
tion and  subcutaneous  inoculation;  from  all  of  these  he  concluded  that 
the  human  tuberculous  virus  acts  on  the  bovine  species  exactly  like  the 
tubercular  virus  which  comes  from  the  bovine  species  itself. 

That  the  diseases  are  not  absolutely  distinct  is  indicated  by  the  fact 
that  tuberculin  made  from  human  bacilli  causes  a  reaction  in  cattle 
affected  with  bovine  tuberculosis.  The  Bureau  of  Animal  Industry 
has  distributed  hundreds  of  thousands  of  doses  of  tuberculin  made 
from  human  bacilli,  and  this  tuberculin  has  been  used  by  State  authori- 
ties in  various  parts  of  the  United  States  for  diagnosing  the  disease  in 
cattle,  and  has  been  found  extremely  reliable  and  satisfactory  for  this 
purpose.  This  fact  would  clearly  indicate  that  if  there  is  a  difference 
between  bacilli  from  human  and  bovine  sources — and  your  committee 
is  inclined  provisionally  to  admit  such  a  difference — it  consists  in  minor 
biological  variations  and  not  in  the  germs  being  .specifically  distinct. 

In  discussing  the  susceptibility  of  man  to  bovine  tuberculosis,  it 
appears  to  your  committee  that  Koch  has  simply  begged  the  question. 
Even  if  we  admit  that  human  tuberculosis  is  not  readily  communicable 
to  cattle,  the  conclusion  that  bovine  and  human  tuberculosis  are  entirely 
different  and  not  intercommunicable  between  these  species  does  not 
necessarily  follow.  Another  possible  conclusion,  and  one  more  in 
harmony  with  what  is  known  of  comparative  pathology,  is  that  the 
bovine  bacillus,  being  proved  more  virulent  for  all  animals  upon 
which  it  has  been  tried,  is  also  more  virulent  for  man. 

As  pointed  out  in  this  committee's  report  of  last  year,  (hero  is  no 
contagion  which  affects  so  many  and  such  widely  separated  species  of 


12  BUREAU  OF  ANIMAL  INDUSTRY. 

animals  as  does  the  bovine  bacillus  and  which  is  not  at  the  same  time 
pathogenic  for  man.  Bovine  tuberculosis  is  communicable  to  horses, 
cattle,  sheep,  hogs,  dog's,  cats,  guinea  pigs,  and  rabbits.  This  is  a 
very  extensive  range  of  pathogenic  power.  What  other  pathogenic 
germ  is  there  which  is  virulent  for  so  many  and  such  widely  separated 
species  and  which  is  not  virulent  also  for  man? 

As  examples  of  diseases  which  affect  many  species  of  animals,  we 
have  anthrax,  rabies,  glanders,  malignant  edema,  and  tetanus,  to  all 
of  which  mankind  is  susceptible.  As  examples  of  diseases  which 
affect  a  fewer  number  of  species,  we  have  epizootic  aphtha,  which 
principally  affects  cattle  and  hogs,  and  which  is  communicable  to 
man:  we  have  vaccinia,  or  cowpox.  which  affects  horses  and  cattle 
and  which  is  communicable  to  man;  we  have  rinderpest,  which  affects 
only  ruminants  and  which  is  not  communicable  to  man;  we  have  pleuro- 
pneumonia  and  Texas  fever,  which  affect  cattle  and  are  not  commu- 
nicable to  man;  and  we  have  sheep  pox,  which  affects  sheep  only,  and 
hog  cholera  affecting  hogs  only,  which  are  not  communicable  to  man. 
The  rule  appears  to  be  that  the  larger  the  number  of  animal  species 
susceptible  the  more  likely  is  a  contagion  to  affect  man.  Surehr  a 
germ  which  is  pathogenic  for  so  many  species  of  animals  as  is  the 
bovine  tubercle  bacillus  should  be  considered  as  dangerous  to  man 
until  positive  evidence  has  proved  its  innocence. 

We  are  not  without  parallel  cases  in  comparative  patholog}-  which 
should  be  considered  in  deciding  such  an  important  question.  One  of 
these  is  found  in  rabies.  When  the  contagion  of  this  disease  is  inoc- 
ulated into  monkeys  and  passed  from  one  animal  of  this  species  to 
another  for  a  few  times,  the  virus,  as  is  well  known,  becomes  so  lack- 
ing in  pathogenic  power  that  it  no  longer  produces  rabies  in  dogs 
when  inoculated  in  the  usual  manner.  It  must  be  apparent  to  all  how 
wrong  it  would  be  to  conclude  that  because  rabies  of  monkeys  is  not 
communicable  to  the  dog,  converse!}'  the  rabies  of  the  dog  is  not 
communicable  to  monkeys;  yet  this  appears  to  be  exactly  the  kind  of 
assumption  which  Koch  has  made  in  regard  to  the  bovine  tubercle 
bacillus. 

Another  parallel  case  is  found  in  variola.  The  variola  of  man, 
commonly  called  smallpox,  is  conveyed  to  cattle  with  much  difficulty. 
Like  human  tuberculosis,  it  produces,  when  inoculated  in  these  ani- 
mals, only  insignificant  results  when  compared  with  the  disease  in 
man,  with  no  tendency  to  generalization  or  to  the  production  of  fatal 
results,  but.  on  the  other  hand,  the  tendency  is  to  retrogression  and 
healing.  Nevertheless,  the  bovine  variola,  known  as  vaccinia,  or 
cowpox,  is  easily  inoculated  upon  man,  develops  to  the  same  extent  as 
in  cattle,  produces  characteristic  lesions,  runs  its  regular  course,  and 
may  be  transferred  from  man  to  man  an  indefinite  number  of  times, 
as  has  been  shown  in  the  practice  of  vaccination.  If  cowpox  had 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  1 -H 

never  been  experimentally  tested  upon  man,  and  we  had  only  the 
results  of  experiments  in  inoculating  smallpox  upon  cattle,  we  should 
have  the  same  reason  for  concluding  that  vaccinia  is  not  communicable 
to  man  that  has  been  cited  in  the  case  of  tuberculosis. 

Koch  alludes  to  two  kinds  of  evidence  available  for  deciding  this 
question  :  First,  the  demonstration  of  cases  of  primary  intestinal 
infection  in  man:  secondly,  the  inoculation  of  cattle  with  bacilli  found 
in  cases  of  human  tuberculosis.  It  appears  to  your  committee  that 
his  treatment  of  this  question  is  very  narrow  and  unsatisfactory.  In 
deciding  as  to  the  susceptibility  of  man  the  evidence  now  available 
may  be  classified  under  four  heads :  (1)  Accidental  inoculations  with 
bovine  bacilli;  (2)  clinical  evidence  of  individuals  infected  by  use  of 
milk;  (3)  statistics  of  abdominal  tuberculosis;  (4)  results  of  post- 
mortem examinations.  We  shall  discuss  the  subject  under  these  four 
heads. 

ACCIDENTAL   INOCULATIONS   OF   MAN    WITH    BOVINE    BACILLI. 

The  first  and  most  important  line  of  evidence  is  that  obtained  from 
accidental  inoculations  of  man  with  bovine  bacilli.  Ravenel4  has  put 
on  record  three  cases  of  veterinarians  in  the  State  of  Pennsylvania  who 
were  accidentally  inoculated  with  bovine  tuberculosis  in  making  post- 
mortem examinations.  Case  1  was  accidentally  wounded  in  the  knuckle 
of  his  forefinger.  The  wound  healed  badly  and  a  nodule  soon  formed 
which  showed  a  decided  tendency  to  ulcerate.  After  some  weeks  he 
had  the  nodule  removed,  and  a  section  of  the  excised  portion  was 
found  to  contain  a  large  giant  cell,  but  tubercle  bacilli  were  not  satis- 
factorily demonstrated  in  the  preparation.  The  nodule  recurred  after 
excision  and  was  finally  cured  by  treatment  in  the  hot-air  apparatus. 
Case  2  was  Ravene!'*  assistant,  who  scratched  his  knuckle  on  the  broken 
end  of  a  rib  in  performing  a  postmortem  on  a  goat  which  had  suc- 
cumbed to  an  experimental  inoculation  with  a  culture  of  bovine 
tubercle  bacillus.  The  wound  healed  promptly,  hut  about  -">  weeks 
afterwards  became  reddened,  swollen,  and  sensitive.  It  grew  worse 
and  was  finally  excised  with  a  margin  of  healthy  skin.  Two  guinea 
pigs  were  inoculated  subcutaneously  with  a  portion  of  this  nodule  and 
both  developed  a  generalized  tuberculosis.  Case  3,  a  well-known 
veterinarian  of  Philadelphia,  wounded  the  knuckle  of  his  forefinger 
in  making  an  autopsy  on  a  tuberculous  cow.  Between  3  and  4  weeks 
afterwards  the  scar  was  noticed  to  be  enlarged,  reddened,  and  some- 
what sensitive.  As  it  showed  no  tendency  to  improve,  but  rather 
grew  worse,  it  was  excised  some  »>  weeks  after  the  inoculation  and  the 
wound  cauterized  with  bromine,  since  which  then'  has  been  no  return. 
The  nodule  was  examined  by  Dr.  .John  (Juiteras.  who  demonstrated 
its  tuberculous  nature  bv  finding  tubercle  bacilli  in  sections. 


14  BUREAU    OF    ANIMAL    INDUSTRY. 

L.  Pfeift'er5  cites  the  ca.se  of  Veterinarian  Moses,  34  years  old,  of 
healthy  famih'  and  personally  in  good  health,  who  pricked  his  left 
thumb  in  making  an  autopsy  on  a  tuberculous  cow.  The  point  of  the 
knife  probably  penetrated  into  the  articulation  of  the  first  and  second 
phalanges.  The  puncture  healed  without  suppuration,  but  at  the  end 
of  ti  months  there  formed  at  the  cicatrix  a  cutaneous  tubercle,  and  the 
joint  was  removed.  Soon  afterwards  the  patient  began  to  cough,  and 
died  of  phthisis  18  months  after  the  accident.  On  opening  the  articu- 
lation of  the  thumb  it  was  found  filled  with  caseous  masses  extraordi- 
narily rich  in  tubercle  bacilli. 

A  somewhat  similar  case  occurred  in  the  practice  of  M.  B.  Hartzell, 
of  Philadelphia,  and  was  partially  reported  at  the  meeting  of  the 
American  Medical  Association,  held  at  Philadelphia  June  1  to  4,  1897. 
Further  details  have  been  received  through  Ravenel.  The  patient,  a 
man  in  excellent  health  and  weighing  175  pounds,  wras  employed  by  a 
railroad  company  to  clean  cars  used  for  the  transportation  of  cattle. 
He  was  wounded  upon  the  back  of  the  hand  by  a  piece  of  broken  wood- 
work  of  a  car,  and  typical  verrucous  tuberculosis  developed  locally. 
This  was  apparently  successfully  treated  by  Hartzell.  Within  a  year 
the  patient's  general  health  changed  greatly;  he  was  emaciated,  had  a 
persistent  cough  with  abundant  expectoration,  and  there  was  a  decided 
dullness  at  the  left  apex,  with  numerous  rales.  Death  soon  resulted 
from  general  tuberculosis. 

A  very  interesting  case  of  "primary  subcutaneous  tuberculosis," 
caused  by  the  topical  application  of  cream,  was  reported  by  Grothan.6 
A  little  girl  6  }'ears  old  had  suffered  from  an  eruption  on  the  left  leg, 
supposed  to  be  due  to  ivy  poisoning.  This  was  treated  at  home  by 
the  topical  application  of  fresh  cream.  When  seen  by  Grothan  there 
was  a  painless  ulcer  of  irregular  shape  the  size  of  a  25-cent  piece  on 
the  posterior  aspect  of  the  leg,  having  the  characteristic  appearance  of 
a  tubercular  ulcer,  with  reddish  tinged  borders  slightly  overhanging 
the  floor,  which  was  covered  with  granulations  and  watery  pus.  There 
were  also  about  a  dozen  light-mahogany  colored  spots  confined  to  the 
calf  of  the  leg  and  the  lower  third  of  the  thigh,  varying  from  the  size 
of  a  hazelnut  to  the  half  of  a  large  walnut,  and  containing  masses  of 
caseous  material.  The  cow  was  examined  and  the  udder  seemed  nor- 
mal, yet  inguinal  and  intraperitoneal  inoculation  of  twTo  rabbits  with 
a  mixture  of  milk  and  cream  gave  positive  results  in  both  inguinal 
inoculations  and  one  peritoneal.  The  caseous  material  from  the  nod- 
ules of  the  girl's  leg  injected  into  the  peritoneum  of  a  rabbit  produced 
tuberculous  peritonitis  and  death  in  about  3  weeks.  The  family  was 
using  milk  from  one  cow  only  at  the  time  the  application  was  made. 

A  somewhat  similar  case  was  recorded  b}'  Coppez.7 

A  girl  17  years  old  had  a  wound  on  the  palmar  aspect  of  the  third  finger  between 
the  second  and  third  phalanx,  which  became  infected  with  tubercle  bacilli  during 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  15 

milking.  The  original  lesions  gave  rise,  within  6  months,  to  over  35  subcutaneous 
abscesses  situated  in  different  parts  of  the  body.  There  were  2  on  the  right  hand,  4 
on  the  elbow,  2  on  the  shoulder  blade,  several  on  the  right  cheek,  2  on  the  left  palm, 
1  on  the  back  of  the  neck,  a  dozen  on  the  buttocks  and  thighs,  4  on  the  left  leg,  3  on 
the  sole  of  one  foot,  and  1  on  the  big  toe.  Most  of  these  were  curetted  and  iodoform 
applied  6  months  after  the  beginning  of  the  disease.  Subsequently  more  appeared— 
in  all  from  60  to  66.  The  author  describes  the  appearance  of  these  foci  as  follows: 

At  a  certain  point,  always  in  the  neighborhood  of  a  preexisting  focus,  a  thickening 
of  the  subcutaneous  tissue  appeared,  associated  with  increased  heat  of  the  skin  and 
pain  on  pressure.  The  heat  soon  disappeared  and  a  fluctuating  livid  tumor  opened 
itself  and  discharged  pus,  and  later  a  yellowish  serum.  These  various  abscesses 
healed  slowly,  and  within  a  year  all  disappeared.  At  no  time  could  any  visceral 
lesions  be  recognized,  but  one  eye  became  involved.  The  nature  of  the  affection  was 
demonstrated  by  inserting  some  pus  from  an  abscess  into  the  eye  of  a  rabbit.  There 
was  but  slight  reaction  at  first.  Subsequently  the  whole  eye  became  diseased,  the 
lymph  nodes  of  the  neck  being  greatly  enlarged.  After  several  months  death  ensued. 

A  third  case  of  tuberculosis  communicated  by  inoculation  with 
infected  milk  was  reported  by  Priester.8 

A  young  man  employed  on  the  docks  tried  to  remove  a  number  of  tattoos  from 
his  hands  and  forearms  by  introducing  milk  into  the  tattooed  parts  by  means  of 
needle  punctures.  This  operation  was  repeated  several  times.  Later  there  appeared 
on  the  back  of  both  hands,  at  points  which  had  been  treated  on  the  same  day,  bright 
red  spots  the  size  of  millet  seeds,  containing  a  yellow  center.  Pus  was  evacuated 
from  several  nodules.  These  were  found  to  be  lupus  nodules  (tuberculosis  of  the 
skin)  in  which  giant  cells  were  demonstrated.  The  diseased  parts  were  cut  out  and 
the  wounds  healed  without  a  recurrence  of  the  trouble. 

Tscherning,9  of  Copenhagen,  treated  a  veterinarian  whose  finger  had 
been  wounded  in  making  a  postmortem  examination  of  a  tuberculous 
cow.  Three  weeks  after  the  accident,  the  slight  wound  having  already 
healed,  the  surrounding  tissues  became  swollen,  and  a  little  later  a 
suppurating  ulcer  formed.  Notwithstanding  an  appropriate  treat- 
merit,  the  local  disease  became  worse  and  it  was  necessary  to  excise 
all  of  the  swollen  tissue.  Microscopic  examination  demonstrated 
tubercles  with  bacilli.  The  patient  recovered  without  further  devel- 
opment of  the  disease. 

M.  T.  Naughton,  Chicago,  111.,  has  communicated  to  this  committee 
the  following  case,  which  was  observed  in  his  practice: 

(i.  K.  W.,  Pole;  age,  34;  weight,  170  pounds;  healthy  looking  man;  butcher  by 
occupation.  Family  history  negative.  Father  of  three  healthy  children.  Ha*  no 
recollection  of  having  In-en  previously  sick.  On  May  3,  1899,  while  cleaning  cattle 
viscera,  he  fell  and  a  stationary  meat  hook  upon  which  hearts  and  lungs  are  hung 
penetrated  through  the  right  hand  between  the  second  and  third  metacarpal  bones. 
A  tendo  vaginitis  resulted,  with  some  lymphangitis  of  the  arm.  He  received  the 
usual  treatment  for  an  infected  wound  and  apparently  made  a  good  recovery,  with, 
however,  some  limited  motion  of  the  fingers  and  a  sensitive  scar  at  the  site  of  punc- 
ture. Four  months  afterwards  iui  abscess  formed  in  the  axilla,  which  was  cleaned 
out  and  tul>ercle  bacilli  were  demonstrated  in  the  broken-down  gland  tissue.  At 
this  time  there  was  no  soreness  in  the  arm  lymphatics  or  ell>ow  gland,  but  he  com- 
plained that  there  hail  been.  In  3  months  afterwards,  or  7  mouths  from  the  original 
accident,  he  died  from  pulmonary  tuberculosis. 


1(>  BUREAU    OF    ANIMAL    INDUSTRY. 

These  are  very  clear  cases  and  could  be  multiplied  if  necessary"  to 
add  strength  to  the  evidence.  These  cases  demonstrate  the  suscepti- 
bility of  man  to  infection  by  bovine  bacilli  inoculated  into  the  skin  or 
subcutaneously.  Not  only  were  local  lesions  produced,  but  in  some 
cases  the  disease  was  generalized  and  ended  in  death.  The  value  of 
such  cases  of  inoculation  in  demonstrating  the  susceptibility  of  man 
has  been  questioned  on  the  ground  that  the  lesions  resulting  from  inoc- 
ulation of  the  skin  are  usually  slight  and  remain  localized.  While  it 
is  true  that  they  remain  localized  in  most  cases,  they  have  sometimes 
been  attended  by  fatal  results,  and  in  all  cases  appear  to  be  at  least  as 
serious  as  similar  inoculations  with  the  human  bacillus.  The  human 
bacillus  is  known  to  be  pathogenic  for  man  and  it  causes  one  of  the  most 
fatal  of  human  diseases.  Now,  if  the  bovine  bacillus,  when  inoculated 
in  the  skin,  produces  at  least  as  serious  results  as  the  human  bacillus 
we  have  a  right  to  conclude  that  mankind  is  equally  susceptible  to  the 
bovine  as  to  the  human  form  of  contagion. 

It  is  reported  that  one  of  the  foreign  delegates  said  in  the  British 
congress  that  the  inoculation  of  man  from  animals  is  a  different  thing 
from  infection  by  way  of  the  alimentary  tract.  While  this  may  be 
admitted,  it  is  nevertheless  true  that  the  human  bacillus,  which  may 
infect  man  by  way  of  the  alimentary  tract,  is  only  inoculated  in  the 
skin  with  difficult}',  as  is  shown  by  the  insignificant  lesions  which  usu- 
ally follow  inoculations  in  making  autopsies  and  dissections.  In  other 
words,  the  alimentary  tract  appears  to  be  a  more  favorable  route  of 
entrance  for  the  human  bacillus  than  is  the  skin,  and  consequently  if 
the  bovine  bacillus  is  able  to  enter  the  body  by  means  of  skin  inocula- 
tions, there  is  every  reason  to  believe  that  it  may  also  enter  by  way  of 
the  alimentary  tract. 

These  very  clear  cases  appear  to  demonstrate  the  communicability 
of  bovine  tuberculosis  to  man  and  to  indicate  that  the  bacilli  from  a 
bovine  source  are  at  least  as  virulent  for  man  as  are  bacilli  from  a 
human  subject.  It  will  not  do  to  put  these  cases  aside,  saying  that 
such  inoculations  are  another  matter  from  intestinal  infection,  because 
the  great  point  to  be  decided  is  the  susceptibility  of  man  to  the  bovine 
bacillus;  and  it  will  be  observed  that  Koch  proposes  in  testing  the  viru- 
lence of  bacilli  from  the  human  subject  to  do  this  by  subcutaneous 
inoculations  in  cattle.  If  such  inoculations  are  a  proper  test  of  sus- 
ceptibility in  the  one  case  why  are  they  not  equally  so  in  the  other? 

TUBERCULOSIS    IN    MAN    BELIEVED    TO    HAVE    BEEN    CAUSED    BY    INGES- 
TION   OF   MILK   FROM   TUBERCULOUS   COWS. 

The  second  class  of  evidence  to  which  your  committee  would  refer 
is  the  clinical  observation  of  individuals  infected  by  the  ingestion  of 
milk.  One  of  these  frequently  cited  is  a  case  reported  by  Ollivier  to 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  17 

the  Paris  Academy  of  Medicine.10  Twelve  girls  contracted  tubercu- 
losis in  a  young  ladies'  boarding  school.  Of  these  5  died.  From  the 
fact  that  the  sick  and  deceased  girls  were  descended  from  healthy 
ancestors  and,  above  all  doubt,  showed  the  phenomena  of  intestinal 
tuberculosis,  there  was  suspicion  of  infection  with  the  food.  Full  con- 
firmation of  this  suspicion  was  found  in  the  slaughter  of  a  cow  which 
for  a  year  had  served  as  a  source  of  milk  supply  for  the  school.  The 
cow  had  extensive  tuberculosis  of  the  intestines  and  udder.  This  case 
has  particular  value  because  of  the  number  of  persons  affected,  the 
fact  that  they  had  intestinal  tuberculosis,  and  the  demonstration  of 
udder  tuberculosis  in  the  cow. 

Another  case  is  cited  by  T.  Percy  C.  Kirkpatrick.11  This  was  the 
case  of  a  daughter  of  a  Dr.  Gosse,  of  Geneva,  reported  by  himself. 
The  girl  up  to  the  age  of  17  had  been  quite  healthy  and  had  no 
history  of  hereditary  taint  or  predisposition  to  tuberculosis.  Early 
in  1893  she  became  ill,  with  more  or  less  vague  and  undefined  symp- 
toms, and  died  in  some  10  months.  Gosse  performed  a  postmortem 
examination,  and  discovered  extensive  tuberculosis  of  the  mesenteric 
glands  and  abdominal  viscera.  When  trying  to  find  the  source  of 
infection  in  this  case,  Gosse's  attention  was  drawn  to  a  small  farm 
which  he  possessed  in  the  country  and  which  he  had  been  accustomed  to 
visit  on  Sundays  with  his  daughter,  and  one  of  her  chief  delights  was 
to  drink  milk  from  the  cows  there.  On  examination  4  of  the  5  cows 
were  tubercular  and  2  had  disease  of  the  udder. 

An  interesting  case  was  under  the  care  of  Thomas  M.  Rotch  in  the 
Children's  Hospital,  in  Boston,  in  1893  or  1894.  The  particulars  were 
sent  to  Dr.  de  Schweinitz,  of  the  Bureau  of  Animal  Industry,  b}r  Rotch. 
A  boy  7  years  old  had  been  drinking  a  great  deal  of  milk  from  one 
cow  for  about  4  months  before  entering  the  hospital.  The  cow  was 
found  to  be  tuberculous,  the  disease  being  demonstrated  by  autopsy. 
The  boy  was  a  case  of  primary  tubercular  peritonitis,  with  effusion. 
Laparotomy  was  performed  by  Dr.  Bradford,  and  a  large  amount 
of  serous  fluid  evacuated.  The  peritoneum  was  found  to  be  thickly 
studded  with  minute  tubercles,  and  the  presence  of  tubercle  bacilli 
was  demonstrated.  Four  years  after  the  operation  the  boy  was  found 
to  be  perfectly  well  and  seemed  free  from  tuberculosis. 

Lydtin  12  gives  the  following  case:  Dr.  Stang,  of  Amorbach,  was 
called  to  a  finely  developed  5-year-old  boy,  the  son  of  healthy  parents, 
with  no  hereditary  taint  in  their  ancestors.  The  boy  died  a  few  weeks 
later  with  miliury  tuberculosis  of  the  lungs  and  enormously  enlarged 
tubercular  mesenteric  glands.  At  the  necropsy  it  was  learned  that  the 
IM>V  had  habitually  drunk  the  milk  of  a  cow  which  had  been  killed 
shortly  before  he  died  and  which  had  shown  pulmonary  tuberculosis. 

Mr.  Howe,  of  North  Hadley,  Mass.,  lost  a  son  JO  months  old  from 
abdominal  tuberculosis  3  months  after  he  paid  a  week's  visit  to  his 
13110— No.  53—04 '2 


18  HURKAT  OF  ANIMAL  INDUSTRY. 

uncle  and  had  been  fed  with  milk  of  the  uncle's  cow.  The  cow  was 
killed  soon  afterwards  and  proved  to  have  generalized  tuberculosis. 
The  child's  sickness  and  wasting1  began  a  few  weeks  after  he  returned 
home.  He  had  previously  been  strong  and  healthy,  as  were  and  are 
his  parents.13 

A  4-year-old  son  of  Colonel  Beecher,  of  Yonkers,  and  grandson  of 
Henry  Ward  Beecher,  died  March  4,  1894,  of  tubercular  meningitis, 
and  the  two  Alderney'  cows  which  supplied  him  milk  were  proved 
tuberculous  by  the  tuberculin  test  and  postmortem  examination. 
There  was  no  hereditary  taint.13 

A  Scotch  family,  strong  and  health}',  had  a  herd  of  cows  which  con- 
tracted tuberculosis.  Two  young  daughters  brought  up  on  the  milk 
died  of  tuberculosis,  wrhile  "2  older  brothers,  using  little  or  no  milk, 
remained  Avell  and  hardy.14 

Dr.  Demme,1''  chief  physician  of  the  Children's  Hospital,  Berne, 
records  the  cases  of  4  children,  born  of  healthy  parents  and  without 
tuberculous  ancestors  either  on  the  paternal  or  maternal  side,  who 
died  of  intestinal  and  mesenteric  tuberculosis,  having  consumed  for 
some  time  .milk  furnished  by  tuberculous  cows.  Among  2,000  tuber- 
culous children  treated  by  Dr.  Demme  in  '20  years,  these  were  the 
only  ones  in  which  he  could  absolutely  exclude  the  possibility  of  heredi- 
tary taint  and  all  other  causes  of  the  disease  except  milk  infection. 

Von  Ruck 1G  records  the  following  case,  which  he  considers  almost 
conclusive: 

M.,  age  33,  weight  180  pounds,  was  treated  by  his  family  physician  about  6  weeks 
for  what  was  supposed  to  be  typhoid  fever.  Growing  worse  when  convalescence  was 
looked  for,  Von  Ruck  was  called  in  consultation.  Diagnosis  of  acute  miliary  tuber- 
culosis was  soon  established.  The  autopsy  showed  the  usual  dissemination  of  the 
tubercular  process,  but  no  old  focus  was  found  in  chest  or  abdomen,  which  only 
were  permitted  to  be  examined.  Family  and  personal  history  good;  and  the  source 
and  mode  of  infection  remained  for  the  time  obscure. 

A  few  days  after  M.'s  death,  Von  Ruck  was  called  to  see  his  nearly  1-year-old 
child  on  account  of  fever  and  diarrhea,  which  yielded  to  treatment,  but  the  child 
did  not  recover  its  former  good  health.  Gradually  symptoms  of  meningitis  devel- 
oped and  the  child  died.  No  postmortem  was  permitted,  but  there  was  no  doubt  of 
the  tubercular  character  of  the  meningitis.  Infection  from  father  was  not  probable, 
the  child  having  been  removed  from  the  house  at  an  early  period  of  his  illness. 

The  milk  which  the  child  had  received  came  from  a  Jersey  cow,  and  no  other  had 
been  used  up  to  the  time  the  diet  was  changed  on  account  of  the  diarrheal  attack. 
The  father  had  drunk  largely  of  this  cow's  milk,  taking  a  pint  and  sometimes  a  quart 
twice  a  day,  warm,  at  the  time  of  milking,  and  this  cow's  milk  was  given  him  exclu- 
sively during  his  entire  illness.  On  examination  one  of  the  cow's  teats  was  found  to 
be  shrunken;  it  was  said  to  yield  little  milk,  and  several  months  before  the  milk  was 
occasionally  bloody.  There  was  a  hard,  irregular  lump  on  the  same  side  of  the 
udder.  When  the  cow  was  killed,  several  months  later,  there  was  found  extensive 
tuberculosis  in  the  lungs  and  peritoneal  cavity,  and  the  lump  in  the  udder  con- 
tained a  caseous  center,  which  on  examination  showed  numerous  well-stained 
tubercle  bacilli. 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  19 

These  are  examples  of  clinical  evidence  which  might  be  greatly 
extended,  but  all  are,  of  course,  open  to  the  objection  that  we  do  not 
know  absolutely  that  the  disease  was  caused  by  the  bovine  bacillus. 
However,  the  occurrence  of  abdominal  tuberculosis  soon  after  the  use 
of  milk  from  tuberculous  cows  is  a  coincidence  which  justifies  us  in 
accepting  the  cases  as  strong  circumstantial  evidence,  not  of  them- 
selves demonstrating  the  communicability  of  bovine  tuberculosis,  but, 
taken  with  other  evidence,  making  a  case  which  it  is  difficult  to  contest. 

STATISTICS   SHOWING    FREQUENCY   OF   ABDOMINAL   TUBERCULOSIS. 

The  third  line  of  evidence  to  which  we  invite  attention  is  the  statis- 
tical data  available  from  various  parts  of  the  world. 

Thome,  in  the  Harben  lectures  for  1898,  shows  from  the  statistics 
of  England  and  Wales  that  between  the  periods  1851-1800  and  1891- 
1895  there  has  been  a  reduction  of  the  mortality  at  all  ages  from 
phthisis  of  45.4:  per  cent,  while  from  all  forms  of  tuberculosis  the 
reduction  has  been  distinctly  less,  namely,  39.1  per  cent.  Taking 
that  form  of  disease  registered  under  the  name  of  "  tabes  mesenterica," 
the  reduction  at  all  ages  has  been  but  8.5  per  cent;  under  5  years  of 
age  the  reduction  has  been  but  3  per  cent;  while  under  1  year  of  age 
there  has  been  an  actual  increase  of  27. 7  per  cent.  This  is  the  milk- 
drinking  age,  and  the  increase  of  the  mortality  is  very  significant  at  a 
time  when  phthisis  has  been  so  remarkably  reduced.  So  instructive 
are  these  statistics  that  we  reproduce  here  Thome's  table  showing  the 
mortality  from  this  disease: 

England  and  Wales — *}fortaliti/  from  tabes  mwenterica  in  xereral  periods,  Itftl-ltff) '/>. 


Period. 

Per  mil- 
lion living 
(all  ages). 

Per  mil- 
lion births 
(under  1 
year). 

Per  mil- 
lion living 
(under  5 
years). 

]S.">1-1HC>0                                                                                                    

•J(R) 

:i,  itm 

1,625 

1W1-1K70                                                 .    .                      .                          

•_M.»5 

H.  X(X) 

l.x-ii; 

1K71-1X80                                          .                              

818 

1,  K',7 

•J.O-2H 

18X1-1KX5                                                .                  

289 

l.:i."xi 

1,852 

1HH4V-1H90                                                        

265 

1,462 

1,761 

1X91-1895.                                               

23X 

1,046 

1  .  ">77 

Reduction  or  inert-use  IHT  cent  t>et\vet>n  1851-18fiO  and  1X91-1X95.. 

—  X.  5 

''_'".  7 

3.0 

The  conclusions  which  naturally  follow  from  these  statistics  are  so 
different  from  the  opinions  of  many  men  that  numerous  attempts  have 
been  made  to  counteract  them.  Some  have  held  that  the  cases  returned 
under  "tabes  mesenterica "  could  not  be  relied  upon  as  abdominal 
tuberculosis.  An  examination  of  the  evidence  presented  leads  your 
committee  to  the  conclusion  that  this  point  is  not  well  taken. 

Still17  has  recorded  the  results  of  7(59  autopsies  on  children  under 
12  years  of  age  at  the  Hospital  for  Sick  Children,  Great  Ormonde 


20  BUREAU    OF    ANIMAL    INDUSTRY. 

street.  Two  hundred  and  sixty-nine  cases  were  found  showing  tuber- 
culous lesions.  In  those  in  which  the  channel  of  infection  could  be 
made  out  with  some  certainty  the  primary  infection  was  as  follows: 
Lung.  105;  intestine,  53;  ear,  9;  bones  or  joints,  5;  that  is,  the 
intestinal  infections  were  to  the  others  as  1  to  2.1.  With  the  class  of 
cases  where  death  was  caused  by  some  other  disease  and  where  tuber- 
culosis either  was  arrested  in  an  early  stage  or  had  not  progressed 
beyond  the  initial  stage,  affording  almost  indisputable  evidence  of  the 
methods  of  infection,  the  infections  wyere  thus:  By  the  lung,  26;  by 
the  intestine.  16;  by  the  ear,  1.  Here  the  intestinal  infections  were 
to  the  others  as  1  to  1.7.  In  the  English  statistics  the  cases  of  tabes 
mesenterica  in  children  of  5  years  and  under  are  to  the  other  forms 
of  tuberculosis  as  1  to  1.6.  Still's  observations  are,  therefore,  a  sin- 
gular indorsement  of  the  accuracy  of  the  returns  under  the  name  of 
tabes  mesenterica.  and  as  the  ages  of  the  children  covered  by  his 
autopsies  were  12  years  and  under,  he  has  really  found  a  larger 
percentage  of  intestinal  infection  than  is  indicated  by  the  statistics. 

Also  J.  Walter  Carr18  refers  to  statistics  of  necropsies  on  tuberculous 
children  at  the  Victoria  Hospital.  He  found  79  in  wrhich  the  disease 
most  probably  started  in  the  chest  and  20  in  which  it  seemed  to  have 
begun  in  the  abdomen.  Here  the  relation  between  the  two  forms  of 
infection  is  1  to  4.  In  26  children  with  early  or  limited  tuberculosis, 
the  thorax  was  alone  affected  in  12  cases  and  the  abdomen  in  7,  being 
in  the  proportion  of  1  to  1.7.  Of  53  tuberculous  children  under  2 
years  of  age  the  disease  most  probably  began  in  the  chest  in  43,  and 
in  only  5  certainly  in  the  abdomen,  the  proportion  in  this  case  being 
as  1  to  8.4.  Out  of  25  children  over  5  years  of  age  the  disease 
began  in  the  chest  in  12  and  in  the  abdomen  in  6,  the  relation  being 
as  1  to  2. 

Shennon19  collected  data  from  postmortem  examinations  at  the 
Royal  Hospital  for  Sick  Children,  Edinburgh,  of  355  cases  of  tuber- 
culosis, in  331  of  which  he  was  able  to  determine  the  channel  of 
infection.  In  67.7  per  cent  it  was  respiratory,  in  28.1  per  cent  it  was 
alimentary.  This  is  as  1  to  2.3. 

These  postmortem  examinations,  all  from  English  sources,  may  be 
accepted  as  f  airly  representative  of  the  results  of  the  postmortem  room, 
and  they  sustain  Thome's  contention  that  the  returns  in  England  of 
tabes  mesenterica  represent  with  reasonable  accuracy  the  abdominal 
tuberculosis  of  children  in  that  country.  It  may  be  added  that  in  Still's 
most  recent  paper2*  he  states  that  "it  would  seem,  therefore,  that,  at 
any  rate  among  hospital  patients  in  London,  nearly  one-third  of  the 
child  mortality  is  due  to  tuberculosis;  and  although  such  an  estimate 
may,  for  various  reasons,  be  too  high  wThen  applied  to  the  whole  child 
mortality  of  this  city,  it  seems  almost  certain  that  the  average  given 
by  the  registrar-general's  statistics  is  far  too  low.  During  the  5  years 


BOVINE    Tt?BERCULOSlS    AND    PrBLIC    HEALTH. 


21 


1891  to  1805  the  average  number  of  deaths  per  annum  from  all  causes 
among1  children  up  to  the  age  of  10  years  in  this  city  was  3t>.3-W;  out 
of  these  the  average  number  of  children  certified  each  year  as  having 
died  of  tuberculosis  was  3,335.  The  evidence  of  postmortem  statistics 
makes  it  practically  certain  that  a  very  much  larger  number  than  this 
died  of  tuberculous  diseases,  and  probably  we  should  be  well  within 
the  mark  if  we  said  that  at  least  0,000  children  die  every  year  in  Lon- 
don alone  from  tuberculosis."  This  being  the  case,  and  the  proportion 
between  tabes  mesenterica  and  other  forms  of  tuberculosis  remaining 
the  same,  there  must  have  been  nearly  twice  as  many  cases  of  intes- 
tinal tuberculosis  in  London  as  were  recorded  by  the  registrar-general; 
but  as  tabes  mesenterica  is  one  of  the  most  obscure  forms  of  the  dis- 
ease, the  probability  is  that  more  children  affected  with  this  form  of 
tuberculosis  were  otherwise  reported  than  was  the  case  with  phthisis, 
tubercular  meningitis,  and  other  forms  of  tuberculosis  that  were  more 
easily  diagnosed.  At  an}-  rate,  it  ma}*  be  accepted  as  certain  that  the 
evidence  so  far  presented  has  sustained  Thome's  conclusions  in  regard 
to  tabes  mesenterica.  This  being  the  case,  your  committee  deems  it 
advisable  to  introduce  at  this  point  the  statistics  of  England  and  Scot- 
land and  some  of  the  principal  cities  of  the  world,  showing  deaths  from 
different  forms  of  tuberculosis. 

Dentli*  from  tuberculous  diseases  in  England  and  Wales  for  Uie  year  1S!~>$. 
[Population  31,397,078.] 


Form  of  disease. 

Under 
1 
year. 

I'uder    Under 
5             10 
years,     years. 

Under 
15 
years. 

Under 
20 
years. 

Under 
years. 

Under 
35 
years. 

All 
ages. 

Tal>es  mesenteries..  . 

3,  265 

5,050       5  369 

5  725 

5  850 

6  050 

6  357 

Tubercular  meningitis  (acute  hy- 
drocephalus)  "... 

Other  forms  of  tuberculosis,  scrofula. 

1,985 
1,319 

4,904       5,791 
2,585       3,035 

6,147 
3,399 

6,339 
3,  851 

6,  451 
4,233 

6,  573 
4,81)7 

6,  681 
5,  766 

Total  other  than  phthisis  
Phthisis  

ti,  569 
493 

12,539      14.195 
1  491        2  l->6 

15,  101 

3  T'7 

15,915 
6  437 

16,534 
11  •>!•> 

17,430 
•'1  007 

is.  MM 
41  335 

Total  tuberculosis  

7,062 

14,030      Hi.  321 

18,  228 

22,  3-~>2 

27,  746 

38  437 

60  139 

Death*  ffom  tnherndoux  disease*  in  Srothmd  for  the  year  IX'.'S. 
[Population  -1,249.946.] 


K<>rm  of  disease. 

Under  1 
year. 

Under  15 
years. 

Under  25       All 
years.        ages. 

Taljes  iiieHenterica 

239 

788 

87''            '117 

Tubercular  meningitis 

350 

1  212 

1  'KM         1  '"88 

Other  forms  of  tuberculosis,  scrofula  

121 

459 

605            SI  5 

Total  other  than  phthisis  

710 

2,  459 

2  740         3  050 

Phthisis  

720 

2  675         7  OiH) 

Total  tuberculosis 

.    .                                        78S 

3  179 

5  415        10  140 

BUREAU    OF    ANIMAL    INDUSTRY. 


Deaths  from  tuberculous  diseases  in  London  for  the  year  /AW. 
[Estimated  iM>pulation,  4,504,766.] 


Form  of  disease. 

Under 
1 
year. 

Under 
5 
years. 

Under    Under 
10            15 
years,     years. 

Under 
20 
years. 

Under 
25 
years. 

Under  i 
35 
years.  | 

All 
ages. 

Tabes  mesenteries  

602 
897 

285 

838 

989 
555 

884 
1,128 
039 

903 
1,177 
693 

915 
1,197 
750 

930 
1,213 
791 

958 
1,232 

S65 

997 
1  ,  250 
983 

<  Itherformsof  tuberculosis,  scrofula. 

Total  other  than  phthisis  
Phthisis. 

1,2*4 
98 

2,  3*2 
308 

2,  051 
385 

2,  773 
4% 

2,  862 
851 

2,  934 
1,517 

3,  055 
3,  272 

3.  230 
7.812 

Total  tuberculosis 

1,3X2 

2,  090 

3,036 

3,  269 

3,713 

4,451 

6,327 
1 

11.042 

Deaths  from  tuberculous  diseases  in  Berlin  for  the  year  189$. 
[Population,  June  30,  1,708,624.] 


Form  of  disease. 

Under    Under 
1              5 
year,      years. 

Under 
10 
years. 

Under 
15 
years. 

Under    Under 
20            25 
years,     years. 

Under 
35 
years. 

All 
ages. 

Tabes  mesenterica                       .   .   . 

4  '         14 

23 

29 

30            35 

45 

71 

Tubercular  meningitis 

39           163 

196 

205 

210          216 

225 

237 

Other  forms  of  tuberculosis,  scrofula. 

20            34 

38 

40 

40            47 

62 

88 

Total  other  than  phthisis  
Phthisis  

63          211 

78           246 

257 
300 

274 
360 

2*0          298 
559           983 

332 
1,807 

3% 
3,553 

Total  tuberculosis 

141           457 

634 

839       1,281 

2  199 

3  949 

Deaths  from  tuberculous  diseases  in  Paris  for  the  year  1897. 
[Population,  18%,  2,511,629.] 


'  Under 
Form  of  disease.                        1 
1   year. 

Under 
6 
years. 

Under 
10 
years. 

Under 
15 
years. 

Under 
20 
years. 

Under 
25 
years. 

Under 
35 
years. 

All 
ages. 

Tabes  mesenterica                                           4 

21 

34 

47 

01 

83 

154 

Tubercular  meningitis  140 

633 

802 

837 

857 

892 

943 

999 

Other  forms  of  tuberculosis,  scrofula.           50 

143 

174 

196 

248 

346 

567 

1,168 

Total  other  than  phthisis  194 
Phthisis                                                            48 

797 
244 

1,010 
325 

1,080 
456 

1,160 
1  038 

1,299 
1  955 

1,593 
4,296 

2,321 

9,298 

Total  tuberculosis.       .                      242 

1,041 

1,335 

1,536 

2,  198 

3,  254 

5,  889 

11,019 

Deaths  from  tuberculous  diseases  in  Xeir  York  City  for  the  year  1899. 
[Estimated  population,  3,550,053.] 


Form  of  disease. 

Under 
1 
year. 

Under 
5 
years. 

Under 
10 
years. 

Under 
15 
years. 

Under 
20 
years. 

Under 
25 
years. 

Under 
35 
years. 

All 
ages. 

Tabes  mesenterica 

34 

40 

40 

40 

40 

40 

42 

45 

Tubercular  meningitis 

281 

676 

750 

766 

781 

795 

819 

804 

Other  forms  of  tuberculosis,  scrofula. 

79 

175 

211 

233 

272 

328 

437 

013 

Total  other  than  phthisis  
Phthisis 

394 
98 

891 
220 

1,001 
269 

1,039 
362 

1,093 

778 

1,163 
1,751 

1,298 
4,316 

1,  522 
8,  015 

Total  tuberculosis          

492 

1,111 

1  270 

1,401 

1,871 

2,914 

5,614 

9,537 

BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH. 

Deaths  from  tuberculous  diseases  in  Boston  for  the  year  1000. 
[Population,  560,892.] 


'23 


Form  of  disease. 

Under  1 
year. 

I'nder  15 
years. 

Under  'Jo 
years. 

All 
ages. 

Tabes  mesenterica          

.« 

20 

10 
117 
51 

12 
123 
79 

18 
131 

1S1 

65 

11 

178  i             -JH 
52               31  S 

330 
1,247 

Phthisis  

76 

•_>30 

532 

1,.Y77 

Deaths  from  tuberculous  diseases  in  Chicago  for  the  years  1897  and 
[Population,  1897,  1,619,226:  1898,  1,650,000.] 


Form  of  disease.                          U"dnerrl 

\  ear. 

Under  5 
years.  . 

Under  10 
years. 

Under  20 
years. 

Under  30 
years. 

All 
ages. 

Tuberculosis  mesenteric  (1897)  and  peri- 
toneal (1898)  

3 
75 
40 

12 
190 

88 

16 
225 
110 

29 
249 
158 

3o 
270 

248 

56 
293 
460 

Tuberculosis,  cerebral  

Total  other  than  phthisis    

118 
66 

290              351 
196              250 

•436 
700 

554 
2,061 

809 
4,596 

Phthisis      

Total  tuberculosis 

184 

486 

601 

1,136 

2,615         5,405 

It  is  evident  from  these  tables  that  abdominal  tuberculosis  is  a  very 
common  disease  in  England,  Wales,  and  Scotland,  and  that  it  is  by  no 
means  unknown  in  the  cities  of  Berlin,  Paris,  New  York,  Boston,  and 
Chicago. 

To  show  more  clearly  the  numerical  relation  of  the  different  forms 
of  tuberculosis,  a  series  of  tables  of  percentages  have  been  compiled, 
corresponding  with  those  just  given,  showing  the  number  of  deaths. 


Deaths  front  tuberculosis  in  England  and  Wales  for  the  >/ear  1$9S. 
[Percentage  of  each  form.] 


Komi  of  disease. 

Under 
1 
year. 

Under 
5 
years. 

Under 
10 
years. 

I'nder 
15 
years. 

Under 
20 
years. 

Under 
25 
years. 

Under 
35 
years. 

All 
ages. 

Tabes  mesenterica 

46.  23 

36.00 

32.90 

30.48 

25.61 

21  .  08 

1">.  74 

10  57 

TutKTcular  meningitis  (acute  hy- 
drocephalus)  

28.11 

31.95 

35.48 

33.  72 

28.36 

23.  25 

17.10 

11.11 

Other  fomiHof  tuberculosis.  scrofula. 
Phthisis... 

18.68 
6.9H 

is.  42 
10.  63 

1*.  59 

13.03 

18.65 
17.15 

17.23 
28.  SO 

15.26 
40.41 

12.  51 
54.  65 

9.  59 
68.73 

Total 100.00      100.00  I   100.00     100.00      100.00      100.00      100.00        100.00 


BUREAU  OF  ANIMAL  INDUSTRY. 


s  from  tuberculosis  in  Scotland  for  tlic  year  18C>8. 
[Percentage  of  each  form.] 


Form  of  disease. 

Under  1 
year. 

Under  15 
years. 

Under  25 
years. 

All 
ages. 

Tube*  mesenteries 

30  33 

24  71) 

1C  10 

')  34 

Tubercular  meningitis 

44  42 

38  13 

23  33 

l->  70 

15  30 

14  44 

11  17 

8  04 

Phthisis      

9  S9 

22.64 

49  40  i 

69  92 

Total 

100  00 

100  00 

100  00  ! 

100  00 

DeaUisfrom  tuberculosis  in  London  for  Ihc  year  1S9S. 
[Percentage  of  each  form.] 


Form  of  disease. 


Under  1    Under  15  Under  25      All 
year.         years,    i    years,    i   ages. 


43  56 

27  62 

20  89 

9  03 

Tubercular  meningitis 

28.72 

36.01 

27  26 

11  32 

Other  forms  of  tuberculosis,  scrofula 

20.63 

21.20 

17  77 

8  90 

Phthisis  

7.09 

15  17 

34  08 

70  75 

Total  

100.00 

100.00 

100.00 

100.00 

Deaths  from  tuberculosis  in  Berlin  for  the  year  1898. 
[Percentage  of  each  form.] 


Under  1    Under  15  Under  25      All 


year. 

years. 

years. 

ages. 

Tabes  mesenterica  

2.84 

4.57 

2.73 

1.80 

Tubercular  meningitis  

27.66 

32.33 

16.86 

6.00 

Other  forms  of  tuberculosis,  scrofula  

14.18 

6.31 

3.67 

2  23 

Phthisis  

55.  32 

56.79 

76.74 

89.97 

Total... 

100.00 

100.00 

100.00 

100.00 

DeatJts  from  tuberculosis  in  Paris  for  the  year  1897. 
[Percentage  of  each  form.] 


Form  of  disease. 


Under  1 
year. 


Tabes  mesenterica  

1.65 

3.06 

1.87 

1.33 

Tubercular  meningitis  

57.85 

54.49 

27.42 

8.60 

Other  forms  of  tuberculosis,  scrofula  . 

20.66 

12  76 

10.63 

10.  05 

Phthisis  

19.84 

29  69 

60  08 

80.02 

Total  

100.00 

100.00 

100.00 

100.00 

Under  15  Under  25      All 
years.    ,    years.    ;   ages. 


BOVINE   TUBERCULOSIS    AND   PUBLIC    HEALTH. 


25 


Deaths  from  tuberculosis  in  Neiu  York  for  the  year  1899. 
[Percentage  of  each  form.] 


Form  of  disease. 


Under  1    Under  15  Under  25      All 
year.     ;    years,    i    years.       ages. 


Tabes  mesenterica 

Tubercular  meningitis 

Other  forms  of  tuberculosis,  scrofula 
Phthisis... 


6.91 
57.11 
1C.  06 
19.92 


Total. 


2. 86 
54.  68 
1C.  C2 
25.84 


1.37  0.47 

27.28  9. 06 

11. 25  6. 43 

00.10  84.04 


100.00  i      100.00         100.00  .     100.00 


Deaths  from  tuberculosis  in  Boston  for  the  year  1900. 
[Percentage  of  each  form.] 


Form  of  disease. 

Under  1 
year.     ; 

Jnder  15 
years,    i 

Under  25  ; 
years. 

All 

ages. 

Tabes  mesenterica 

2.63 

4.35 

2  26 

1  14 

Tubercular  meningitis 

56.58 

50  87 

23  12 

8  31 

Other  forms  of  tuberculosis,  scrofula  
Phthisis  

26.  32 
14  47 

«>:>  }~ 
22  61 

14.85 
59  77 

11.48 
79  07 

Total  

100  00 

100  00 

100  00 

100  00 

Deaths  from  tuberculosis  in  Chicago  for  the  years  1897  and  1898. 
[Percentage  of  each  form.] 


Form  of  disease. 

Under  1 
year. 

Under  5 
years. 

Under  10 
years. 

Under  20 
years. 

Under  30 
years. 

All 

ages. 

Tuberculosis,  mesenteric  (1897)  and  peri- 
toneal (1898)  

1  63 

2  47 

2  66 

2  55 

1  38 

1  04 

Tuberculosis,  cerebral  . 

40.76 

39  09 

37  44 

21  92 

10  33 

5  42 

Tuberculosis,  other  organs  

21.74 

18.11 

18.30 

13.91 

9.48 

8.51 

Phthisis  

35  87 

40  33 

41  60 

61  62 

78  81 

85  03 

Total  

100.00 

100  00 

100  00 

100.00 

100  00 

100  00 

NOTE. — In  these  tables  the  term  "  tabes  mesenterica"  is  believed  to  cover  tuberculosis  of  the  intes- 
tines, peritoneum,  and  abdominal  lymphatic  glands. 

Taking  England  and  Wales,  it  is  seen  that  in  children  under  1  year 
old  tabes  mesenterica  constitutes  46.23  per  cent  of  the  total  cases  of 
tuberculosis  at  that  age,  while  phthisis  constitutes  but  6.D8  per  cent. 
Under  5  years  the  figures  are  36  per  cent  for  tabes  mesenterica  and 
10.63  per  cent  for  phthisis.  It  is  not  until  the  age  of  20  years  is 
reached  that  the  percentage  of  phthisis  exceeds  that  of  tabes  mesen- 
terica. In  Berlin,  Paris,  New  York,  Boston,  and  Chicago  the  statis- 
tics, however,  are  quite  different,  and  the  number  of  cases  of  abdominal 
tuberculosis  returned  is  very  much  smaller. 

Your  committee  has  added  a  table  compiled  from  these  statistics 
showing  the  deaths  per  million  population  from  the  different  forms  of 
tuberculosis  in  England,  Wales,  and  Scotland,  and  in  the  cities  men- 
tioned. Erom  this  table  (p.  *2(\)  the  extreme  frequency  of  intestinal 
tuberculosis  in  England  and  Scotland  is  made  manifest. 


26  BUREAU    OF    ANIMAL    INDUSTRY. 

Deaihs  per  million,  population  from  different  forms  of  tuhcrcnloxix. 


Form  of  disease. 

England 
and 
Wales, 

1898. 

Scot- 
land, 

1898. 

Lon- 
don, 

1898. 

Ber- 
lin, 

1898. 

Paris, 
1897. 

New- 
York, 
1899. 

Bos- 
ton, 
1900. 

Chi- 
cago, 

1897-98. 

Under  1  i/ear. 
Tube1*  mesenterica 

104 

66 

134 

•> 

10 

,j 

1 

Tubercular  meningitis 

63 

88 

9') 

56 

79 

23 

Other  forms  of  tuberculosis,  scrofula  
Phthisis 

42 
16 

29 
18 

03 

11 

41 

20 
1() 

22 

35 

°0 

12 

•>o 

Total  tuberculosis  

225 

185 

307 

79 

97 

139 

130 

50 

Under  lii  years. 

177 

185 

200 

16 

19 

11 

18 

Under 
•20. 
9 

Tubercular  meningitis 

190 

285 

•>(')! 

110 

333 

°1G 

009 

70 

Other  forms  of  tuberculosis,  scrofula  
Phthisis  

MS 
100 

108 
109 

154 
110 

23 
203 

78 
182 

00 
102 

91 

93 

48 
214 

Total  tuberculosis 

581 

747 

725 

358 

01° 

395 

411 

347 

Under  25  years. 
Tabes  mesenterica  .         

186 

205 

200 

20 

24 

11 

21 

Undo- 
SO. 
11 

Tubercular  meningitis 

205 

297 

209 

122 

355 

224 

919 

83 

Other  forms  of  tuberculosis,  scrofula  
Phthisis 

135 
357 

142 
029 

170 
337 

20 
550 

138 
778 

92 
493 

141 

507 

76 
630 

Total  tuberculosis  

883 

1,274 

988 

724 

1,295 

820 

948 

800 

A  11  ages. 

202 

223 

221 

40 

61 

13 

32 

17 

Tubercular  meningitis  

213 

303 

278 

134 

398 

243 

234 

90 

Other  forms  of  tuberculosis,  scrofula  
Phthisis  

184 
1,317 

192 
1,068 

218 
1,734 

50 
2,009 

405 
3,702 

173 
2,258 

322 
2,  223 

141 

1  406 

Total  tuberculosis 

1,910 

2  380 

2,451 

2  233 

4  620 

2  687 

2  811 

1  054 

The  one  point  which  it  is  desired  to  impress  at  this  time  is  that 
abdominal  tuberculosis  is  not  so  rare  that  it  can  properly  be  ignored 
and  that  the  statistics  of  some  countries  show  a  remarkable  number  of 
cases. 

POSTMORTEM   EXAMINATIONS    SHOWING    INTESTINAL   TUBERCULOSIS. 

The  fourth  line  of  evidence  bearing  upon  this  question  is  obtained 
from  postmortem  examinations. 

Koch  says  that  among  many  cases  of  tuberculosis  examined  after 
death  he  remembered  having  seen  primary  tuberculosis  of  the  intes- 
tine only  twice.  Among  the  great  postmortem  material  of  the  Charite 
Hospital,  in  Berlin,  10  cases  of  primary  tuberculosis  of  the  intestine 
occurred  in  5  years.  Among  933  cases  of  tuberculosis  in  children  at 
the  Emperor  and  Empress  Frederick's  Hospital  for  Children,  Bag- 
insky  never  found  tuberculosis  of  the  intestines  without  simultaneous 
disease  of  the  lungs  and  the  bronchial  glands.  Among  3,104  post- 
mortems of  tubercular  children,  Biedert  observed  only  10  cases  of 
primary  tuberculosis  of  the  intestine. 

Are  these  selected  statistics,  or  are  the  results  of  postmortems  in 
Germany  so  different  from  what  they  are  in  England? 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  27 

In  269  autopsies  of  tuberculous  children,  Still20  determined  the  chan- 
nel of  infection  with  some  degree  of  certainty  in  216  cases,  and  in  63 
of  these  primary  infection  was  probably  through  the  intestine.  Carr,31 
in  a  series  of  120  autopsies  on  tuberculous  children  at  the  Chelsea 
Children's  Hospital,  found  that  16.  T  per  cent  showed  evidence  of 
primary  abdominal  infection.  Guthrie,22  at  the  Paddington  Green 
Children's  Hospital,  in  a  series  of  77  cases,  found  evidence  of  primary 
intestinal  infection  in  19  cases.  Shennon23  collected  355  cases  of 
tuberculosis  from  the  postmortems  at  the  Royal  Hospital  for  Sick  Chil- 
dren, Edinburgh,  in  331  of  which  he  was  able  to  determine  the  chan- 
nel of  infection.  In  28.1  per  cent  of  these  cases  it  was  alimentary. 
Bellinger,  in  his  address  at  the  International  Tuberculosis  Congress  at 
Berlin  in  1899,  quoted  with  approval  the  autopsies  by  Heller  (Kiel)  of 
248  tuberculous  children,  which  showed,  in  45.5  per  cent  of  the  cases, 
tuberculosis  of  the  mesenteric  glands.  From  these  it  was  concluded 
that  milk  played  a  leading  role  in  the  so-called  transmitted  tuberculosis 
of  children. 

Northrup24  refers  to  125  postmortems  at  the  New  York  Foundling 
Asylum  on  tuberculous  children,  in  34  of  which  the  bronchial  nodes 
were  large  and  cheesy,  likewise  the  mesenteric  nodes;  the  lungs  con- 
tained tubercles,  as  did  the  liver,  spleen,  kidneys,  and  meninges.  The 
primary  seat  of  infection  in  these  was  not  clear.  In  the  remaining  91, 
3  were  primarily  of  mesenteric  lymph  node  infection,  and  88  were 
primarily  of  bronchial  node  infection. 

G.  Sims  Woodhead,25  in  1894,  writing  on  channels  of  infection  in 
tuberculosis,  said: 

I  have  seen  in  case  after  case  in  children  and  in  animals  fed  on  tuberculous  mate- 
rial, the  lungs  markedly  affected,  but  in  a  large  proportion  of  these  cases  it  has  l>een 
possible  to  trace  the  course  of  invasion  back  from  an  old  caseous  or  calcareous  mesen- 
teric gland,  through  the  chain  of  retroperitoneal  glands,  up  through  the  diaphragm  to 
the  posterior  mediastinal  and  bronchial  glands,  and  soon  to  the  lung.  I  have  not 
seen  this  in  a  few  cases  only,  but  in  dozens  of  children,  in  a  few  adults,  and  in  many 
animals. 

Sheridan  Peh'pine,26  Proctor  professor  of  pathology,  Owens  College, 
in  a  lecture  on  tuberculosis  and  the  milk  supply,  said: 

A  very  striking  proof  of  the  frequency  of  infection  through  the  intestine  fell  under 
my  notice  <>  years  ago.  Dr.  Simcock  was  investigating  in  my  laboratory  the  pathol- 
ogy of  chronic  wasting  of  children  due  to  improper  feeding.  He  selected  13  cases 
out  of  many  more  in  which  there  was  no  evidence  of  tulH-rcnlosis  in  the  parents  or 
in  the  various  organs  of  the  children  a^examined  in  the  jM>stmortem  room.  He  con- 
sidered these  cases  free  from  tuberculosis.  I  was  not,  however,  quite  convinced. 
We  carefully  examined  the  mesenteric  glands  of  all  these  children  with  the  object  of 
discovering  whether  (-ome  might  not  be  tuberculous.  In  2  of  these  cases  the  mesen- 
teric glands  showed  clear  tul>erculous  lesions  under  the  microseoi>e,  and  in  5  more 
the  mesenteric  glands  presented  lesions  suggesting  the  possibility  of  incipient  tul>er- 
culosis.  The  presence  of  '_'  clear  cases  of  tuberculosis  among  !.'{  cases  carefully 
selected  as  free  from  tuberculosis  is  socially  significant. 


28  BITREAIT    OF    ANIMAL    INDUSTRY. 

These  quotations  are  sufficient  to  make  it  clear  that  primary  intes- 
tinal infection  is  much  more  frequent  than  is  indicated  by  Koch's 
paper.  After  expressing  himself  '"that  a  case  of  tuberculosis  has 
been  caused  by  alimenta  can  be  assumed  with  certainty  only  when  the 
intestine  suffers  first — i.  e.,  when  so-called  primary  tuberculosis  of  the 
intestine  is  found" — he  first  endeavors  to  show  that  such  cases  are 
extremely  rare,  and  then  proceeds  to  contradict  his  first  assertion  that 
it  can  be  assumed  with  certainty  to  have  been  caused  by  alimenta,  by 
saying  "it  is  by  no  means  certain  that  such  cases  are  due  to  infection 
by  bovine  tuberculosis,  it  being  just  as  likely  that  they  were  caused 
by  the  widely  propagated  bacilli  of  human  tuberculosis  which  may 
have  got  into  the  digestive  canal  by  some  way  or  other,  for  instance, 
by  swallowing  saliva  of  the  mouth." 

It  is  clear  that  dust  and  bacilli  inhaled  with  the  air  are  deposited 
upon  the  mucous  membrane  of  the  nose,  pharynx,  and  trachea,  and 
that  such  inhaled  particles  must  bo  swallowed  unconsciously,  as 
pointed  out  by  Lord  Lister  in  his  letter  to  the  British  Medical  Jour- 
nal (August  3,  1901);  also  that  persons  infected  with  pulmonary 
tuberculosis  swallowed  enormous  numbers  of  bacilli.  Still  it  is 
known  from  postmortem  examinations  that  pulmonary  tuberculosis 
is  more  common  than  intestinal,  and  that  a  considerable  proportion 
(placed  by  Lord  Lister  at  one-third)  of  the  people  who  die  of  pulmo- 
nary tuberculosis  escape  intestinal  infection,  although  they  are  proved 
susceptible  and  have  passed  into  their  stomachs  great  quantities  of 
bacilli  daily  for  months  or  years.  What  is  the  explanation  of  this? 
With  even  the  inhaled  bacilli  more  likely  to  follow  the  digestive  than 
the  respiratory  tract,  why  is  not  intestinal  tuberculosis  much  more 
common  than  the  pulmonary  form  I 

Writers  have  attempted  to  explain  this  by  supposing  that  the  intes- 
tine is  an  unfavorable  position  for  the  bacilli  to  gain  entrance  to  the 
tissues.  Judging  by  the  ease  with  which  animals  are  infected  by 
bovine  bacilli  through  the  digestive  tract,  this  explanation  is  hardly 
tenable.  It  would  appear  rather  that  the  true  cause  of  the  phenomenon 
is  the  lack  of  pathogenic  power  in  the  human  bacillus^  which  has  been 
shown  experimentally  on  animals,  and  that  this  lack  of  virulence  makes 
it  difficult  for  human  bacilli  to  withstand  the  gastric  juice  and  other 
unfavorable  conditions  and  have  sufficient  activity  remaining  to  infect 
the  body  after  reaching  the  intestine.  On  the  other  hand,  the  more 
virulent  bovine  germ  would  be  more  likely  to  maintain  its  activity 
and  would  be  more  apt  to  produce  infection  with  a  smaller  number  of 
germs. 

The  fact  is  that  in  some  countries  intestinal  tuberculosis  is  compara- 
tively rare,  even  with  children.  The  statistics  of  Berlin.  Paris,  Newr 
York,  Boston,  and  Chicago  prove  this,  although  pulmonary  tubercu- 
losis is  very  prevalent.  Surely  the  air  and  the  habitations  of  these 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  29 

places  must  contain  a  maximum  number  of  bacilli  from  the  human  dis- 
ease. If  intestinal  tuberculosis  is  caused  by  such  human  bacilli,  either 
inhaled  or  taken  into  the  mouth  in  other  ways,  why  is  there  not  as  much 
intestinal  tuberculosis  in  those  cities  as  in  England  and  Scotland?  Are 
British  babies  the  only  ones  that  swallow  the  inhaled  bacilli?  How  can 
we  explain  the  occurrence  of  13 A  cases  of  tabes  mesenterica  per  mil- 
lion inhabitants  in  children  under  1  year  in  London  as  against  only  2 
cases  in  Paris,  when  there  are  more  than  twice  as  many  cases  of  pul- 
monary tuberculosis  per  million  inhabitants  in  Paris  as  in  London? 
We  see  here,  as  in  the  statistics  brought  forward  by  Thome,  that  there 
is  no  relation  between  intestinal  tuberculosis  and  pulmonary  tubercu- 
losis: in  other  words,  that  infection  by  human  bacilli  apparent!}'  plays 
a  yen-  subordinate  part  in  the  causation  of  tuberculosis  of  the  abdomi- 
nal organs.  This  conclusion  we  think  is  legitimate  and  clearly  follows 
from  the  statistics  presented. 

Why  is  tabes  mesenterica  so  prevalent  in  Great  Britain?  It  is  a 
question  which  can  properly  be  answered  only  by  careful  inquiiy  in 
that  country.  Tuberculosis  is  very  common  among  the  cattle  there, 
but  possibly  not  more  so  than  on  the  continent.  More  attention 
appears,  however,  to  be  given  to  the  inspection  of  meat  in  Berlin  and 
Paris  than  in  London,  and  possibly  the  same  may  be  true  of  milk. 
Meat  is  more  frequently  eaten  underdone  in  London,  and  milk  is 
probably  less  frequently  sterilized.  In  the  United  States  we  haye  far 
less  tuberculosis  among  cattle,  and  also  an  efficient  Federal  meat 
inspection.  Our  milch  cows  do  not  show  more  than  one-tenth  and 
our  beef  cattle  not  more  than  one  hundredth  of  the  tuberculosis  which 
is  found  in  Great  Britain. 

Before  closing  this  discussion  your  committee  desires  to  call  atten- 
tion to  the  fact  that  infection  of  the  lungs  is  not  always  the  result  of 
inhaled  bacilli.  There  is  apparently  as  much  opportunity  for  bacilli 
taken  with  the  food  to  infect  the  pharyngeal,  tracheal,  bronchial,  and 
mediastinal  glands  and  the  lungs  as  there  is  for  inhaled  bacilli  to 
infect  the  intestine.  When  all  cases  of  pulmonary  tuberculosis  are 
cited  as  necessarily  due  to  inhaled  bacilli  and  as  not  by  any  possibility 
due  to  infection  with  the  food,  an  error  is  committed. 

G.  Sims  Woodhead20  several  years  ago  pointed  out  how  frequently 
bacilli  gained  entrance  through  the  lymphoid  tissue  of  the  tonsil,  and 
St.  Clair  Thomson  has  recently  expressed  the  opinion  that  all  germs 
are  deposited  before  the  ail'  reaches  the  larynx  and  that  infection  most 
probably  occurs  through  the  lymphoid  tissue  of  the  naso-pharynx  and 
pharynx.  He  says:  "There  appears  to  be  no  justification  for  the 
generally  accepted  idea  that  the  bacillus  is  inhaled  directly  into  the 
pulmonary  alveoli." 


30  BUREAU    OK    ANIMAL    INDUSTRY. 

Ho  also  says  of  infection  through  the  pharynx: 

In  many  of  these  cases  the  process  can  be  traced  from  the  glands  in  the  tonsil  clown 
into  the  neck  and  so  on  to  the  thorax  by  the  mediastinal  and  post-sternal  glands  and 
by  the  intercostal  lymphatics  and  glands,  and  it  is  interesting  in  such  cases  to  note 
ho\v  the  lungs  may  be  perfectly  healthy  until  the  glands  at  their  root  or  in  the  pleura 
have  become  distinctly  affected. 

Again  he25  says: 

We  have  also  an  example  of  secondary  affection  of  the  lungs  following  tubercle  of 
the  pharyngeal  tonsilar  structures,  through  the  glands  in  the  neck,  then  those  in  the 
thorax,  and  finally  to  the  lung  itself,  in  the  examples  that  have  already  been  given 
in  the  infection  of  the  pig  by  tuberculous  milk,  etc.  Moreover,  I  have  seen  a  similar 
line  of  invasion  in  children. 

Koch  tells  us  that  in  an  experiment  in  which  sputum  was  fed  to  6 
pigs  there  was  no  trace  of  tuberculosis  found  postmortem  "except 
here  and  there  little  nodules  in  the  lymphatic  glands  of  the  neck,  and 
in  one  case  a  few  gray  nodules  in  the  lungs."  It  appears,  then,  that 
he  did  get  some  infection  in  the  pigs  by  feeding  human  sputum,  and 
that  the  lesions,  far  from  being  in  the  intestines,  were  in  the  neck  and 
lungs. 

Referring  to  the  pigs  which  had  eaten  bacilli  of  bovine  tuberculosis, 
Koch  says  they  w'had,  without  exception,  severe  tubercular  diseases, 
especially  tubercular  infiltration  of  the  greatly  enlarged  lymphatic 
glands  of  the  neck  and  of  the  mesenteric  glands,  and,  also,  extensive 
tuberculosis  of  the  lungs  and  spleen."  There  is  nothing  said  about 
primary  tuberculous  lesions  of  the  intestines,  and  we  are  forced  to 
the  conclusion  that  his  own  postmortem  notes  do  not  sustain  his  con- 
tention that  such  lesions  are  essential  in  cases  of  infection  through 
contaminated  food.  Lord  Lister27  is  said  to  have  pointed  out  in  his 
reply  to  Koch  that  if  primary  intestinal  tuberculosis  were  rare  in 
children,  mesenteric  tuberculosis  was  common,  and  said  that  the  inter- 
pretation seemed  to  him  to  be  that  the  bacilli  passed  through  the 
intestinal  mucous  membrane  without  causing  any  obvious  lesion  and 
were  arrested  in  the  glands.  This  interpretation  seems  to  be  accepted 
by  most  pathologists,  and  is  certainly  in  harmony  with  the  results  of 
feeding  experiments  with  animals.  Most  forms  of  primary  abdomi- 
nal tuberculosis,  whether  affecting  the  intestines,  peritoneum,  lym- 
phatic glands,  spleen,  or  liver,  are,  therefore,  in  all  probability  due  to 
infection  through  the  intestine.  More  than  this,  many  cases  of  neck 
and  lung  infection  are  due  to  bacilli  taken  with  the  food.  Ravenel28 
has  recently  said: 

Dr.  Pearson  and  I  have  held  for  a  long  time  that  food  tuberculosis  may  appear 
first  in  the  lungs  or  cervical  glands.  I  have  just  received  a  letter  from  Dr.  Pearson 
saying  that  he  has  killed  two  cows  fed  on  tuberculosis  matter,  and  "both  had  exten- 
sively tubercular  lungs,  and  lesions  nowhere  else.  The  postpharyngeal  lymph 
glands  were  normal.  Neither  had  the  slightest  disease  along  the  digestive  tract." 
We  have  made  similar  observations  repeatedly  on  dogs  and  pigs. 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  31 

Observations  of  the  same  kind  have  been  frequently  made  in  the 
experiments  of  the  Bureau  of  Animal  Industry. 

If,  therefore,  it  is  true  and  may  be  admitted  that  some  cases  of 
intestinal  tuberculosis  are  caused  by  bacilli  inhaled  or  which  reach  the 
saliva  from  the  affected  lung,  it  is  also  true  that  in  even  a  larger  num- 
ber of  cases  the  respiratory  organs  are  infected  by  bacilli  taken  with 
the  food.  Certainly  this  is  the  case  with  animals,  as  shown  by  feeding 
experiments,  and  probably  also  with  the  human  subject.  The  location 
of  the  lesions  is  therefore  a  very  uncertain  guide  in  many  cases  as  to 
the  channel  by  which  the  infection  entered  the  bod}'. 

The  new  method  of  diagnosis  which  Koch  desires  us  to  accept- 
namely,  the  culture  of  the  bacillus  and  the  subcutaneous  inoculation  of 
cattle  with  the  cultures — is  yet  of  doubtful  reliability.  It  has  been 
assumed  by  Smith  and  Koch  that  the  bacilli  of  bovine  tuberculosis,  if 
they  produce  disease  in  man,  would  retain  their  peculiar  characteristics 
indefinitely,  so  that  when  isolated  from  the  human  lesions  and  inocu- 
lated in  cattle  they  could  be  identified  by  their  virulence  for  bovine 
animals.  This  is  an  assumption  which  has  never  been  demonstrated. 
The  method  may  or  may  not  be  correct,  and  it  is  only  reasonable  for 
us  to  decline  to  accept  it  for  deciding  so  important  a  question  until 
after  its  efficiency  and  reliability  have  been  demonstrated.  Koch  says: 
"Hitherto  nobody  could  decide  with  certainty  in  such  a  case  whether 
the  tuberculosis  of  the  intestine  was  of  human  or  of  animal  origin. 
Now  we  can  diagnose  them."  It  is  only  just  to  our  own  countryman 
to  say  that  we  could  make  the  diagnosis  as  well  after  the  publication 
of  Theobald  Smith's  paper  three  years  ago  as  we  can  after  reading 
Koch's  address.  But  the  method  is  still  in  its  infancy,  and  no  one  has 
cultivated  germs  known  to  be  of  bovine  origin  that  have  existed  for 
some  time  in  the  human  subject  to  determine  whether  or  not  they 
retain  their  distinctive  properties.  Bacilli  from  different  cases  of 
human  tuberculosis  differ  in  virulence,  and  the  extremes  of  pathogenic- 
power  in  such  bacilli  have  never  yet  been  established/'  It  is  also  true 
that  bacilli  from  bovine  sources  differ  in  virulence,  and  here  again  the 
extremes  of  virulence  have  never  been  determined.  Moreover,  we 
do  not  know  how  much  or  how  soon  the  bovine  bacillus  is  modified 
when  it  propagates  itself  in  human  tissues.  The  experiments  of  Smith 

al-artigauw  has  recently  reported  the  results  of  interesting  investigations  on  the 
range  of  variation  of  the  virulence  of  tubercle  bacilli  from  various  classes  of  lesions 
in  human  beings.  He  concludes  that  tubercle  bacilli  of  widely  different  virulence 
may  exist  in  different  cases  of  human  tul>erculosis.  One  specimen  which  he 
encountered  presented  distinctive  features  worthy  of  note.  "Its  growth  was  of  very 
slow  development,  the  colonies  few  in  numl>er,  and  not  unlike  ground  glass,  an 
apj>earance  to  which  Theobald  Smith  has  referred  in  connection  with  tul>ercle 
bacilli  of  bovine  origin.  When  the  extreme  virulence  of  this  tulx-rcle  bacillus  for 
guinea  pigs  and  rabbits  is  associated  with  the  morphological  anil  cultural  peculiari- 
ties just  noted,  the  whole  closely  suggests  the  bacillus  tuberculosis  of  Ixn-ine  derivation 
as  descril>ed  by  Smith." 


#2  BUREAU  OF  ANIMAL  INDUSTRY. 

have  opened  np  a  wide  field  and  lead  to  important  suggestions  but  we 
can  not  yet  say  what  conclusions  will  be  reached  by  experimenting 
along  the  suggested  lines. 

It  is  to  be  observed  that  Koch  does  not  positively  answer  the  ques- 
tion as  to  the  susceptibility  of  man  to  bovine  tuberculosis,  but  acknowl- 
edges that  it  "  will  not  admit  of  absolute  decision  to-day  or  to-morrow." 
He  insists  that  ''if  such  susceptibility  really  exists,  the  infection  of 
human  beings  is  but  a  very  rare  occurrence,"  and  estimates  "the 
extent  of  the  infection  by  the  milk  and  flesh  of  tuberculous  cattle,  and 
the  butter  made  of  their  milk  as  hardly  greater  than  that  of  hereditary 
transmission."  This  language  shows  his  uncertaint}*  on  the  great 
question  which  he  has  raised  and  bearing  upon  which  he  has  offered  so 
little  evidence.  If  the  extent  of  the  infection  from  bovine  sources 
equals  that  by  hereditary  transmission,  then  the  danger  exists,  it  is  a 
real  danger,  and  we  should  strive  to  ascertain  its  exact  extent  and  how 
much  greater  it  may  become." 

To  ask  the  medical  profession  at  this  time  to  adopt  sweeping  gen- 
eralizations on  inconclusive  experiments  and  on  mere  hypotheses  is 
absurd.  To  expect  that  the  definite  and  positive  evidence  from  acci- 
dental inoculations,  clinical  observations,  vital  statistics,  and  post- 
mortem records  will  be  discarded  in  order  to  adopt  such  hasty 
,  generalizations  is  ridiculous.  More  positive  evidence  will  doubtless 
be  forthcoming  in  the  near  future,  as  investigators  will  not  rest  until 
the  most  exhaustive  researches  have  been  made.  In  the  end  even  this 
dramatic  promulgation  of  a  dangerous  doctrine,  practically  unsup- 
ported by  facts,  will  bring  good  to  the  cause  of  sanitation.  What  we 
must  guard  against  is  the  influence  of  the  sensationalists  and  of  those 
very  impressionable  persons  who  are  ever  ready  to  accept  a  new 
doctrine  which  comes  with  the  sanction  of  authority,  no  matter  upon 
how  slight  a  foundation  of  fact  it  rests. 

In  this  case  it  is  reassuring  to  find  that  the  British  Congress  on 
Tuberculosis  not  only  did  not  accept  the  doctrine,  but  declared  that 
"medical  officers  of  health  should  continue  to  use  all  the  powers  at 
their  disposal,  and  relax  no  effort  to  prevent  the  spread  of  tubercu- 
losis by  milk  and  meat."  In  this  conclusion  your  committee  most 
emphatically  concurs. 

"If  it  were  true  that  man  is  entirely  insusceptible  to  bovine  tuberculosis,  it  would 
appear  that  monkeys,  the  animals  most  closely  related  to  man,  should  also  be  insus- 
ceptible or  at  least  should  not  be  easily  infected  with  bovine  bacilli.  An  experiment 
of  the  Bureau  of  Animal  Industry,  concluded  shortly  after  this  report  was  presented, 
indicates,  on  the  contrary,  that  these  animals  are  extremely  susceptible  to  this  form 
of  tuberculosis.  A  baboon  inoculated  subcutaneously  showed  an  ulcer  locally,  great 
enlargement  of  the  axillary  glands,  and  later,  symptoms  of  acute  generalized  tuber- 
culosis. After  death  the  lungs,  liver,  and  spleen  in  particular  were  found  filled  with 
tubercles  and  other  organs  were  more  or  less  involved.  Another  monkey  of  a  differ- 
ent species,  inoculated  at  the  same  time,  has  become  greatly  emaciated  and  has 
probably  also  contracted  the  disease.30 


BOYINE  TUBERCULOSIS  AFFECTING  THE  PUBLIC 
HEALTH.    (Second  report.)" 

By  D.  E.  SALMON-,  D.  V.  M., 

Chief  of  the  Bureau  of  Animal  Industry  and  Chairman  of  the  Commit  ti'e  on  Animal 
Diseases  and  Animal  Food  of  the  American  Public  Health  Association. 

Your  committee  on  animal  diseases  and  animal  food  respectful!}' 
report  as  follows  with  reference  to  subjects  which  have  received  their 
attention  during  the  time  that  has  elapsed  since  the  last  meeting  of 
the  association: 

The  last  report  which  this  committee  had  the  honor  to  submit  dis- 
cussed the  important  question  of  the  relation  of  bovine  tuberculosis  to 
the  public  health,  reviewed  the  data  available  at  that  time,  and  con- 
cluded that  the  weight  of  evidence  was  overwhelmingly  against  the 
assertion  of  Koch  that  cattle  are  insusceptible  to  human  tuberculosis 
and  that  man  is  insusceptible  to  bovine  tuberculosis.  As  anticipated 
in  that  report,  numerous  investigators  at  once  instituted  researches, 
and  the  results  of  the  experiments  are  now  being  made  public.  Your 
committee  feel  that  the  question  is  of  such  general  interest,  and, 
indeed,  that  its  elucidation  is  so  essential  to  the  proper  performance 
of  the  duty  of  the  sanitarian,  that  they  venture  to  review  it  again  in 
the  light  of  the  most  recent  information  attainable.  There  are  some 
apparent  inaccuracies  in  the  paper  which  Koch2  read  before  the  British 
Congress  on  Tuberculosis,  to  which  your  attention  is  invited.  He  says: 

Even  in  my  first  circumstantial  publication  on  the  etiology  of  tuberculosis  I 
expressed  myself  regarding  the  identity  of  human  tuberculosis  and  bovine  tul>ercu- 
losis  with  reserve. 

A  reference  to  the  paper  which  Koch  mentions  will  show  that  he 
expressed  himself  as  follows:81 

It  is  not  the  peculiar  structure  of  the  tubercle,  not  its  lack  of  blood  vessels,  not 
the  presence  of  giant  cells,  that  will  give  the  solution,  but  rather  the  proof  of  the 
tuberculosis  bacilli,  whether  it  be  in  the  tissue  by  means  of  staining  reaction  or 
whether  it  be  by  means  of  culture  upon  coagulated  blood  serum.  This  criterion 
being  adopted  as  a  foundation  principle,  according  to  my  investigations,  miliary 
tul>erculosis,  caseous  pneumonia,  caseous  bronchitis,  intestinal  and  glandular  tul>er- 
culosis,  bovine  tul>erculosis,  spontaneous  and  inoculation  tuberculosis  of  animals 
must  l>e  declared  as  identical. 

"Report  of  committee  on  animal  diseases  and  animal  food  to  American  Public 
Health  Association  at  New  Orleans,  I^a.,  December  8-12,  1W2.  Published  also  in 
Nineteenth  Annual  Report  of  Bureau  of  Animal  Industry. 

13110— No.  53—04 3 


34  BUBEAU    OF    ANIMAL    INDUSTRY. 

Again  ho31  says: 

The  tuberculosis  of  domesticated  animals,  especially  bovine  tuberculosis,  undoubt- 
edly forms  another  source  of  infection  with  tuberculosis.  By  this  is  also  characterized 
the  position  which  the  care  of  health  is  to  occupy  in  the  future  in  consideration  of 
the  harmfulness  of  the  meat  and  of  the  milk  of  animals  suffering  with  bovine  tuber- 
culosis. Bovine  tuberculosis  is  identical  with  human  tuberculosis,  and  therefore  a 
disease  transmissible  to  man.  It  is  therefore  to  be  treated  just  like  other  infectious 
diseases  transmissible  from  animals  to  human  beings.  However  great  or  small  may 
be  the  danger  which  results  from  the  consumption  of  meat  or  milk  affected  with 
bovine  tuberculosis,  it  is  present,  and  must  therefore  be  avoided.  It  is  sufficiently 
well  known  that  meat  affected  with  anthrax  is  eaten  by  many  persons  and  often  for 
long  periods  of  time  without  harm,  and  yet  no  one  will  draw  the  conclusion  from 
this  that  the  traffic  in  such  meat  is  to  be  permitted. 

It  is  hardly  necessary  to  add  that  the  question  appears  to  have  been 
treated,  in  the  paper  mentioned,  without  any  reservations  whatever, 
and  that  the  statements  of  the  identity  of  human  and  bovine  tubercu- 
losis were  emphatic  and  unequivocal.  Of  course,  it  is  allowable  for 
an  author  to  change  his  views  with  the  discovery  of  additional  facts, 
but  he  may  not  cite  his  earlier  paper  in  support  of  the  later  conten- 
tion when  the  language  of  the  earlier  paper  gives,  as  in  this  case,  an 
opposite  impression. 

Again,  with  reference  to  the  results  of  the  earlier  investigators  of 
the  subject,  he2  states: 

If  one  studies  the  older  literature  of  the  subject,  and  collates  the  reports  of  the 
numerous  experiments  that  were  made  in  former  times  by  Chauveau,  Guenther 
and  Harms,  Bellinger,  and  others,  who  fed  calves,  swine,  and  goats  with  tubercular 
material,  one  finds  that  the  animals  that  were  fed  with  the  milk  and  pieces  of  the 
lungs  of  the  tubercular  cattle  always  fell  ill  of  tuberculosis,  whereas  those  that  received 
human  material  with  their  food  did  not. 

In  your  committee's  last  report32  quotations  were  made  from 
ChauveauV  paper  showing  clearly  that  in  his  experiments  cattle  were 
successfully  infected  with  human  tuberculous  material  by  ingestion, 
by  intravenous  injection,  and  by  subcutaneous  inoculation.  From  all 
of  these  experiments  he  concluded  that  the  human  tubercular  virus 
acts  on  the  bovine  species  exactly  like  the  tubercular  virus  which 
comes  from  the  bovine  species  itself. 

Bollinger33  in  1879  and  Sidney  Martin34  in  1895  also  obtained  suc- 
cessful results  with  bovine  animals,  one  by  inoculation  into  the  perito- 
neal cavity,  the  other  by  feeding  sputum.  Your  committee  have  not 
been  able  to  consult  the  papers  of  Guenther  and  Harms,  which  were 
also  cited  by  Koch,  but  whatever  their  results  may  have  been  it  is 
sufficiently  demonstrated  that  the  older  investigators  were  not  unani- 
mous in  finding  that  ''the  animals  that  were  fed  with  the  milk  and 
pieces  of  the  lungs  of  tubercular  cattle  always  fell  ill  of  tuberculosis, 
whereas  those  that  received  human  material  with  their  food  did  not." 
What  is  most  striking  in  a  review  of  these  earlier  investigations  is 
the  variability  of  the  results.  Chauveau  found  human  as  virulent  as 


BOVINE    TUBERCULOSIS    AND   PUBLIC    HEALTH.  35 

bovine  material  for  bovine  animals.  Martin  found  human  sputum 
much  less  virulent  than  bovine  material,  while  others  failed  entirely  in 
the  effort  to  infect  bovine  animals  with  human  tuberculous  material. 

It  would  seem  that  the  cause  of  this  lack  of  harmony  in  the  results 
of  experiments  of  the  same  character  should  have  been  suggested  by 
the  researches  of  Vagedes.35  who,  in  1896,  studying  "2S  human  cul- 
tures, discovered  1  of  these  which  was  much  more  virulent  than  the 
others,  and  which  was  more  virulent  than  either  of  '2  bovine  cultures 
used  in  the  investigation.  • 

Theobald  Smith36  says  in  regard  to  this  work: 

It  is  somewhat  remarkable  that  this  exceptional  culture  of  Vagedes,  described 
in  a  work  done  under  the  direction  of  Koch  himself,  was  wholly  ignored  by  the 
latter. 

Lartigau29  in  1901  published  results  from  which  he  concluded  that 
tubercle  bacilli  of  widely  different  virulence  may  exist  in  different 
cases  of  human  tuberculosis.  One  culture  obtained  by  him  was 
extremely  virulent  for  guinea  pigs  and  rabbits,  and  had  morphological 
and  cultural  peculiarities  which  closely  suggested  the  bacillus  tuber- 
culosis of  bovine  derivation  as  described  by  Smith. 

Koch2  says  of  his  experiments: 

In  some  cases  the  tubercle  bacilli  or  the  sputum  were  injected  under  the  skin,  in 
others  into  the  peritoneal  cavity,  in  still  others  into  the  jugular  vein.  Six  animals 
were  fed  with  tubercular  sputum  almost  daily  for  7  or  8  months;  4  repeatedly  inhaled 
great  quantities  of  bacilli,  which  were  distributed  in  water  and  scattered  with  it  in  the 
fo.rm  of  spray.  None  of  these  cattle  (there  were  19  of  them)  showed  any  symptoms 
of  disease,  and  they  gained  considerably  in  weight. 

For  the  discrimination  between  human  and  bovine  bacilli  he  recom- 
mends the  subcutaneous  inoculation  of  bovine  animals.  Investigators 
who  have  since  endeavored  to  elucidate  the  subject  have  therefore 
endeavored  to  infect  animals  with  human  material  by  any  one  o:- 
more  of  these  methods  which  failed  in  the  hands  of  Koch  and  his 
assistants.  It  is  very  interesting  to  study  their  results. 

RECENT    RESEARCHES   WITH     REFERENCE   TO   THE   COMMUXICABILITY    OF 
HUMAN    TUBERCULOSIS   TO   ANIMALS. 

Ravenel,37  of  the  Pennsylvania  Live  Stock  Sanitary  Board,  and  a 
member  of  this  committee,  in  1S98  fed  4  calves  with  human  sputum. 
Postmortem  examination  proved  that  all  had  become  affected  with 
tuberculosis,  the  lesions  in  2  being  quite  extensive.  In  March.  1901, 
he  obtained  material  from  the  mesenteric  glands  of  a  child  which  died 
of  tubercular  meningitis.  The  bacilli  from  this  material  have  proved 
very  virulent  for  bovine  animals.  One  calf  inoculated  intravenously 
with  a  suspension  of  a  culture  of  this  bacillus  showed  marked  illness 
during  life  and" died  in  17  days.  Both  lungs  were  found  thickly  stud- 
ded throughout  with  miliary  nodules.  The  bronchial  and  mediastinal 


36  BUREAU  OF  ANIMAL  INDUSTRY. 

glands  were  much  enlarged  and  soft,  the  former  showing  small  areas 
of  caseation.  The  liver  was  soft  and  friable,  and  several  nodules  were 
visible  on  its  surface. 

A  second  calf  was  inoculated  into  the  peritoneal  cavity  with  a  similar 
suspension  of  a  culture  of  this  bacillus.  This  animal  died  in  27  days, 
after  showing  an  abnormally  high  temperature  from  the  eighth  da}'. 
It  was  greatly  emaciated,  having  lost  37  pounds  in  weight.  The  cen- 
tral and  posterior  portions  of  the  lungs  showed  many  areas  deep  in 
color  and  solid  to  the  feel.  These  were  thickly  studded  throughout 
with  minute  grayish  nodules.  The  suprasternal  lymph  glands  wrere 
as  large  as  goose  eggs,  and  contained  cheesy  areas.  The  mediastinal 
glands  were  much  enlarged.  The  peritoneum  was  everywhere  enor- 
mously thickened  and  practically  converted  into  a  tuberculous  mass. 
The  omentum  and  liver  contained  many  nodules. 

A  cow  was  inoculated  intravenously  with  only  2.5  c.  c.  of  a  suspen- 
sion of  a  similar  culture  and  died  in  17  days.  The  lungs  were  thickly 
studded  throughout  with  miliary  nodules. 

A  second  culture  obtained  from  the  mesenteric  glands  of  a  child, 
and  which  in  its  manner  of  growing  and  microscopical  appearance  led 
the  investigator  to  consider  it  a  typical  human  culture,  was  found  to 
be  unexpected!}-  virulent  when  tested  upon  dogs.  A  calf  inoculated 
intravenously  with  suspension  of  a  culture  was  killed  on  the  forty- 
sixth  day,  death  then  appearing  imminent.  The  anterior  lobes  of  both 
lungs  were  thickly  studded  with  minute  nodules  averaging  1  mm.  in 
diameter.  The  bronchial  and  mediastinal  glands  were  enlarged,  and 
scrapings  from  the  cut  surfaces  showed  an  enormous  number  of 
tubercle  bacilli.  Many  yellow  nodules  were  seen  in  the  mediastinal 
glands.  In  the  liver  were  many  minute  nodules,  sections  of  which 
showed  large  numbers  of  tubercle  bacilli.  The  spleen  showed  round- 
cell  infiltration,  giant  cells,  and  many  tubercle  bacilli.  There  were 
also  white  areas  in  the  kidneys  with  round-cell  infiltration  and  many 
bacilli. 

In  the  Bureau  of  Animal  Industry  a  number  of  virulent  cultures  of 
tubercle  bacilli  have  been  obtained  from  human  sources.  A  few  of 
these  are  worthy  of  notice  in  this  connection.  De  Schweinitz,30  of 
the  Biochemic  Division  of  the  Bureau  of  Animal  Industry,  isolated 
a  tubercle  bacillus  from  a  mesenteric  gland  of  a  child  affected  with 
tubercular  peritonitis.  This  bacillus,  when  grown  on  egg  medium, 
corresponded  to  the  bovine  type.  A  calf  received  intravenously  5.5 
c.  c.  of  a  suspension  made  from  an  egg  culture.  This  animal  died  in 
20  days  of  generalized  tuberculosis.  The  lungs  were  a  mass  of  small 
tubercles,  while  the  bacilli  were  demonstrated  in  the  liver,  spleen, 
kidneys,  and  mesenteric  and  mediastinal  glands.  The  same  investi- 
gator obtained  a  culture  from  another  child  affected  with  peritoneal 
tuberculosis.  This  culture  also  corresponded  to  the  bovine  type 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  37 

when  grown  on  egg  medium.  A  calf  inoculated  intravenously  with 
5  c.  c.  of  a  suspension  of  egg  culture  died  in  17  days.  The  autopsy 
showed  generalized  tuberculosis,  numerous  bacilli  being  demonstrated 
in  the  lung,  liver,  spleen,  and  mediastinal  glands.  A  steer  was  inocu- 
lated subcutaneously  with  a  piece  of  tuberculous  tissue  from  this 
child.  The  animal  was  killed  at  the  end  of  6  months,  and  the  autopsy 
showed  the  flank  and  shoulder  glands  enlarged,  caseous,  and  calcified. 
There  were  numerous  excrescences  upon  the  border  of  the  lung  and 
upon  the  pleural  surface  of  the  diaphragm.  Bacilli  were  demonstrated 
in  these  excrescences  and  also  in  the  glands.  Both  of  these  cultures  are 
therefore  very  virulent  for  bovine  animals  when  given  by  intravenous 
inoculation,  and  one  at  least  is  virulent  when  injected  subcutaneously. 

A  calf  previously  tested  with  tuberculin,  as  was  done  with  all  the 
larger  animals  used  in  these  experiments,  was  inoculated  subcutane- 
ously in  the  side  of  the  neck  with  5  c.  c.  of  a  suspension  of  a  culture 
of  this  bacillus.  This  animal  presented  the  ordinary  signs  of  tuber- 
cular infection,  and,  being  emaciated,  weak,  unable  to  rise,  and  in  a 
dying  condition,  was  killed  on  the  thirty-first  day.  The  autopsy 
showed  generalized  tuberculosis.  The  prescapular  gland  and  medias- 
tinal glands  were  enlarged  and  tubercular,  the  lungs  were  filled  with 
tubercular  nodules,  and  the  liver  was  affected  to  an  almost  equal 
extent.  The  omentum  showed  many  tubercular  nodules  and  the 
kidneys  a  small  number. 

Mohler,38  of  the  Pathological  Division  of  the  Bureau  of  Animal 
Industr}',  has  obtained  three  cultures  of  bacilli  from  human  sources 
which,  because  of  their  virulence  for  the  species  of  animals  on  which 
they  have  been  tested,  are  also  worthy  of  mention.  One  of  these, 
which  had  its  source  in  the  mesenteric  gland  of  a  girl  who  died  of 
tuberculosis,  appears  more  virulent  for  goats  and  cats  than  the  first 
culture  of  Ravenel  above  mentioned.  A  goat  inoculated  subcutaneousl y 
was  in  poor  condition  and  growing  thinner  at  the  end  of  137  days. 
A  cat  inoculated  in  the  same  manner  died  in  KM  days  of  pulmonary 
tuberculosis.  A  rabbit  was  in  poor  condition  at  the  end  of  137  days. 
The  bacilli  cultivated  in  dog  serum  averaged  2  /*  in  length,  some 
slightly  curved  and  beaded.  This  bacillus  was  of  the  human  type,  but 
when  recovered  from  the  cat  it  was  markedly  reduced  in  length  and 
slower  in  growth. 

Another  bacillus  obtained  from  the  mesenteric  gland  of  a  boy  affected 
with  tuberculosis  is  shorter,  averaging  from  1.2  to  1.5  ^u,  is  headed, 
and  grows  rapidly  and  luxuriantly.  A  goat  inoculated  subcutaneously 
with  this  culture  died  in  37  days  with  miliary  tul>erculosis  of  the 
lungs,  involving  the  axillary  and  prescapular  glands.  A  dog  inocu- 
lated in  the  same  manner  after  5!>  days  was  thin  and  becoming 
emaciated,  and  had  an  ulrer  at  the  point  of  inoculation.  A  cat  simi- 
larly inoculated  was  in  poor  condition  at  the  end  of  55>  days.  The 


38  BUREAU  OF  ANIMAL  INDUSTRY. 

third  germ,  obtained  by  Mohler,  is  particularly  worthy  of  attention, 
because  it  was  isolated  from  human  sputum.  It  is.  when  grown  on 
dog' serum.  1.7  to  '2. '2  ^  in  length,  slender,  beaded,  and  curved.  A 
yoat  inoculated  subcutaneouslv  died  in  95  days  of  pulmonary  tubercu- 

o  •/«/&«> 

losis.  There  were  also  tubercular  lesions  at  the  point  of  inoculation 
and  in  the  prescapular  gland.  A  cat  inoculated  subcutaneouslv  died 
in  23  days  of  generalized  tuberculosis.  A  rabbit  inoculated  in  the 
same  manner  died  in  59  days  of  pulmonary  tuberculosis.  A  bovine 
culture  was  used  for  comparison  with  the  cultures  just  described  and 
killed  a  goat  in  55  days,  as  compared  with  37  days  for  the  second 
human  culture  and  95  days  for  the  third  human  culture.  The  bovine 
germ  also  killed  a  rabbit  in  69  days  as  compared  with  59  days  for  the 
third  human  culture.  This  work  also  shows  that  it  is  not  a  difficult 
matter  to  obtain  very  virulent  tubercle  bacilli  from  human  sources, 
and  that  some  of  these  are  just  as  virulent  as  bovine  bacilli. 

At  the  British  Congress  on  Tuberculosis,  Thomassen39  reported  an 
experiment  in  which  a  calf  was  inoculated  in  the  anterior  chamber 
of  the  eye  with  a  pure  culture  of  a  tubercle  bacillus  isolated  from  a 
case  of  tuberculous  arthritis  in  man.  When  killed  after  6  weeks,  it 
was  found  that  both  lungs  contained  numerous  miliary  tubercles  and 
some  gray  h'brous  tubercles  of  larger  size.  The  path  of  infection 
from  the  eye  to  the  lung  could  be  traced  by  the  condition  of  the  sub- 
parotideal,  cervical,  mediastinal,  and  bronchial  lymph  glands  of  the 
same  side. 

De  Jong40  reports,  as  a  result  of  a  series  of  inoculations,  that  7 
bovine  animals,  namely.  2  calves  6  months  old,  3  steers  2  years  old,  1 
18  months,  and  1  calf  7  or  S  months  old,  all  became  tuberculous  by  the 
injection  of  tubercle  bacilli  of  human  origin.  Consequent!}'  all  the 
bovine  animals  used  in  the  experiment  were  infected  by  human  bacilli. 
The  disease  produced  was  serious  and  very  extended  in  only  1  animal, 
with  4  others  it  had  a  retrogressive  tendency,  and  in  the  2  remaining 
cases  it  was  progressive.  He  concludes  that  these  results  demonstrated 
that  bacilli  isolated  from  the  human  bod}'  or  from  sputum  are  capable 
of  causing  tuberculosis  of  cattle. 

Delepine41  recently  stated,  in  a  discussion  on  the  relationship  of 
human  and  bovine  tuberculosis,  that  he  had  been  able  to  obtain  from 
the  human  subject  bacilli  just  as  virulent  as  the  bovine  tubercle  bacillus, 
but  in  most  the  human  tubercle  bacillus  was  less  virulent. 

Orth 42  made  experiments  with  3  calves,  3  hogs,  and  3  goats.  The 
infectious  material  was  obtained  from  a  case  of  phthisis  cavernosus 
by  inoculating  a  guinea  pig  and  then  obtaining  cultures  from  this 
animal  from  brain  and  other  media.  In  the  experiments  bouillon  cul- 
tures of  the  organism  were  used,  and  in  some  cases  tuberculous  organs 
from  rabbits.  One  calf  inoculated  into  the  lung  through  the  trachea 
gave  an  entirely  negative  result.  The  second,  inoculated  between  the 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  89 

abdominal  muscles,  showed  only  a  local  caseous  abscess.  The  third, 
which  was  inoculated  in  the  peritoneal  cavity  with  two  pieces  of  tuber- 
culous kidney  from  a  rabbit,  died  on  the  twenty-sixth  day  of  a  general 
tuberculous  peritonitis.  The  serous  membranes  were  covered  with 
miliary  and  submiliary  tubercles.  The  great  omentum  had  nodules 
scattered  throughout  and  small  nodules  were  visible  on  the  serous  mem- 
brane of  the  intestine.  The  mesenteric  portal  and  retrosternal  lymph 
glands  were  much  enlarged  and  showed  gray  and  white  nodules  upon 
section.  There  was  no  doubt  but  that  a  progressive  fatal  tuberculosis 
was  produced  in  this  calf  by  material  originating  in  the  human  subject. 

Of  the  3  pigs,  2,  which  were  inoculated  intraperitoneally  with  the 
bouillon  culture,  gave  negative  results.  The  third,  inoculated  through 
the  trachea  into  the  lungs,  was  killed  after  5^  months  and  a  large  num- 
ber of  miliary  and  submiliary  tubercles  were  found  in  the  inferior  lobe 
of  the  right  lung,  arid  there  were  many  yellowish  tuberculous  nodules 
in  the  thymous  gland  and  in  the  membranes  around  it.  One  of  the 
goats  inoculated  through  the  trachea  into  the  lung  with  the  bouillon 
culture  showed  a  number  of  subcutaneous  nodules  near  the  point  of 
inoculation,  a  large  caseous  nodule  in  the  thymous  gland,  and  a  num- 
ber of  yellowish  gray  nodules  in  the  inferior  lobe  of  the  right  and  left 
lungs.  The  second  goat  was  inoculated  intraperitoneally  with  a  small 
piece  of  lung  from  a  tuberculous  rabbit.  The  animal  was  killed  after 
5  months  and  a  number  of  nodules  were  found  in  the  muscles  and  sub- 
cutaneous tissue  at  the  point  of  inoculation.  There  were  also  a  num- 
ber of  small,  grayish  translucent  nodules  scattered  through  the  omen- 
tum. on  the  diaphragm,  and  in  the  neighborhood  of  the  lymph  glands; 
a  nodule  about  the  size  of  a  pea  was  found  on  the  anterior  border  of 
the  liver.  The  third  goat  was  inoculated  with  a  piece  of  tuberculous 
spleen  the  size  of  a  pea  placed  in  the  peritoneal  cavity.  On  autops}*  a 
number  of  tubercles  were  found  around  the  point  of  inoculation.  There 
was  a  large  group  of  caseous  nodules  on  the  adjoining  surface  of  the 
stomach  and  numerous  caseous  nodules  in  the  omentum,  many  of  these 
latter  having  small  pedicles.  Tubercle  bacilli  were  easily  demon- 
strated, and  there  was  no  doubt  as  to  the  tuberculous  character  of  the 
lesions  nor  that  they  were  produced  by  human  tubercle  bacilli. 

Stenstrom43  inoculated  8  calves  in  various  ways  with  tuberculous 
sputum  rich  in  tubercle  bacilli.  Of  these,  the  following  showed 
positive  results:  No.  224  was  inoculated  intraperitoneally  with  5  c.  c. 
sputum.  When  killed,  after  (>  months,  the  autopsy  showed  many 
calcified  nodules  upon  the  omentum  and  an  enlargement  of  the  glands 
connected  therewith.  Many  miliary  tubercular  foci  were  present  in 
the  liver,  and  the  posterior  lobe  of  the  right  lung  showed  hypertrophy 
of  the  connective  tissue  on  its  serous  cover.  No.  820  was  inoculated 
in  the  lungs  with  20  c.  c.  When  killed,  after  4  months,  it  showed 
many  tubercular  growths  on  the  costal  and  diaphragmatic  pleura,  and 


40  BUREAU    OF    ANIMAL    INDUSTRY. 

tubercular  nodules  in  two  mediastinal  glands.  No.  883  was  inoculated 
intratracheally  on  October  8  with  6  c.  c.  and  on  November  8  with  10  c.  c. 
of  sputum;  was  killed  March  17  and  showed  partialh'  calcified  nodules 
in  the  posterior  and  anterior  mediastinal  glands  and  also  in  the  bron- 
chial glands.  Stenstrom  disagrees  with  Koch  and  states  that  he 
found  it  quite  easy  in  his  experiments  to  infect  cattle  with  human 
tuberculosis. 

Fibiger  and  Jensen44  attempted  to  answer  the  question  as  to  the 
intercommunicability  of  human  and  bovine  tuberculosis  by  selecting 
from  the  various  hospitals  of  Copenhagen  those  cases  of  tuberculosis 
in  which  the  autopsy  indicated  a  primary  intestinal  infection.  They 
report  in  all  5  cases  of  tuberculosis  in  the  following  subjects:  (1)  A 
42-year-old  woman,  (2)  an  11-year-old  girl,  (3)  a  6-year-old  bo}T,  (4)  a 
19-months-old  girl,  and  (5)  a  4-months-old  boy.  A  3-months-old  calf 
was  inoculated  in  the  thoracic  cavity  with  a  suspension  made  from  a 
mesenteric  gland  of  case  No.  1.  This  calf  remained  apparent!}7  in 
good  condition  and  was  killed  at  the  end  of  6  months.  Two  miliaiy 
tubercles  and  a  few  fresh  pearl  nodules  were  found  on  the  pleura.  A 
3-months-old  calf  was  inoculated  with  a  suspension  made  from  the 
spleen  of  a  guinea  pig  which  had  been  inoculated  with  a  mesenteric 
gland  from  case  No.  2.  When  killed,  at  the  end  of  the  fifth  month, 
there  were  found  a  large  number  of  small  red  growths  and  about 
twenty  small  fresh  pearl  nodules  on  the  omentum.  On  the  diaphragm 
there  were  some  small  nodules  and  excrescences  and  one  small  excres- 
cence on  the  pulmonary  pleura.  A  calf  was  inoculated  intraperitone- 
ally  with  a  suspension  made  from  the  spleen  of  a  guinea  pig  which  had 
been  inoculated  from  case  No.  3.  When  killed,  after  about  5  months, 
the  omentum  was  found  tilled  with  tuberculous  growths  and  showed 
countless  small  nodules  of  varying  size.  There  were  some  small  nod- 
ules found  on  other  portions  of  the  peritoneum  and  the  surface  of  the 
spleen,  liver,  and  diaphragm  was  covered  with  small  pearl  nodules. 
A  calf  was  inoculated  subcutaneously  on  the  right  side  of  the  neck 
with  a  suspension  made  from  a  mesenteric  gland  of  case  No.  4.  When 
killed,  at  the  end  of  the  third  month,  there  was  a  large  caseous  mass  at 
the  point  of  inoculation;  the  neighboring  glands  were  large,  caseous, 
and  calcined;  the  lungs  had  scattered  through  them  many  small  miliaiy 
nodules,  and  there  were  a  number  of  excrescences  attached  to  the 
pulmonary  pleura.  The  bronchial  and  posterior  mediastinal  glands 
were  enlarged,  hard,  and  contained  fresh,  caseous,  and  calcined 
nodules.  On  the  surface  of  the  liver  there  were  10  small  pearl  nodules. 
Miliaiy  tubercles  were  scattered  through  the  liver  and  spleen,  and  the 
omentum  was  tilled  with  tine,  diffused,  red  new  growths. 

Two  10-days-old  calves  were  inoculated  subcutaneously  on  the  side 
of  the  neck  with  a  .suspension  made  from  a  mesenteric  gland  from  case 
No.  5.  Both  of  these  animals  died  within  3  weeks  from  secondary 


BOVINE    TUBERCULOSIS    AND   PUBLIC    HEALTH.  41 

infection.  Nevertheless,  there  developed  a  considerable  local  tuber- 
culosis rich  in  bacilli.  From  calf  No.  2  a  third  calf  was  inoculated 
subcutaneously  on  the  right  side  of  the  neck.  A  large  abscess  formed 
at  the  point  of  injection,  and  the  calf,  being  in  a  dying  condition,  was 
killed  at  the  end  of  about  2  months.  The  autopsy  showed,  in  addition 
to  the  local  lesions,  tuberculosis  of  the  adjacent  lymph  glands,  with 
many  new  growths  on  the  costal  and  diaphragmatic  pleura  and  a  few 
on  the  pulmonary  pleura.  The  lungs  contained  a  countless  number  of 
small  nodules,  in  some  portions  so  close  together  that  the  air  was  prac- 
tically absent.  The  bronchial  and  mediastinal  glands  were  enlarged 
and  caseous;  the  liver,  spleen,  and  kidneys  had  miliary  tubercles 
scattered  through  them.  The  intestinal  wall  was  very  rich  in  fresh 
nodules  and  small  superricial  ulcerations.  The  mesenteric  glands 
were  enlarged  and  tuberculous.  The  omentuin  was  rich  in  small  new 
growths.  A  cow  about  10  years  old  was  inoculated  on  the  left  side  of 
the  neck  with  material  from  calf  No.  1  and  developed  an  abscess  at 
the  point  of  inoculation.  When  killed,  at  the  end  of  4  months,  in 
addition  to  the  local  abscess,  the  neighboring  glands  were  enlarged, 
caseous,  and  calcified.  Miliary  tubercles  were  scattered  through  the 
lungs,  a  nodule  the  size  of  a  pea  was  found  in  the  posterior  mediastinal 
gland,  and  a  small  number  of  miliary  tubercles  in  the  liver.  The 
authors  say  that  it  is  thus  seen  that  in  the  3  cases  of  tuberculosis  in 
children  the  bacilli  present  were  virulent,  some  of  them  in  the  highest 
degree  for  calves,  and  it  is  probable  that  the  disease  in  children  was 
caused  by  bacilli  which  came  from  cattle.  In  the  5  cases  there  were 
found  bacilli  having  the  greatest  variation  in  virulence  for  calves,  from 
those  which  were  entirety  avirulent  to  those  which  were  slightly  vir- 
ulent, virulent,  and  of  the  highest  virulence.  They  conclude  by  stating 
that  Koch  announced  that  one  could  distinguish  between  human  and 
bovine  tuberculosis  by  inoculating  calves  subcutaneously.  If  this  is 
true,  then  they  are  of  the  opinion  that  3  of  the  cases  just  cited  must 
be  considered  as  "perlsucht,"  and  the  idea  that  tuberculosis  of  cattle 
is  not  virulent  for  men  is  disproved. 

Max  \Volff  *5  reports  inoculations  from  a  case  of  primary  tubercu- 
losis of  the  intestines  in  man  which  he  considers  fully  meets  all  the 
requirements  demanded  b\r  Koch  for  the  experimental  solution  of  this 
uncommonly  important  question.  Two  guinea  pigs  were  inoculated 
witli  diseased  spleen.  Seven  or  8  weeks  afterwards  they  gave  unmis- 
takable evidence  of  being  tuberculous,  and  were  in  consequence 
killed.  In  each  animal  both  lungs  were  studded  with  nodules  of  the 
size  of  a  pin  head;  the  liver  contained  numerous  submiliary  nodules, 
and  a  swollen,  cheesy  gland  was  located  at  the  hylus  of  this  organ. 
The  spleen  was  studded  with  nodules,  many  of  them  exceeding  the 
size  of  a  pin  head.  A  calf  was  inoculated  in  the  side  of  the  neck 
with  12  c.  c.  of  sterilized  wat«ir  in  which  bits  of  a  lung  and  spleen  from 


42  BUREAU    OF    ANIMAL    INDUSTRY. 

the  guinea  pig  had  been  macerated.  Microscopic  examination  of  this 
material  showed  tubercle  bacilli  to  be  present  in  very  scanty  num- 
bers. Eighty-three  days  after  inoculation  the  calf  was  killed.  It  had 
become  considerably  emaciated.  The  autopsy  revealed  very  severe 
changes  at  the  point  of  inoculation  and  characteristic  pearl  disease  in 
the  internal  organs.  Upon  the  surface  of  the  pleura  were  numerous 
pedunculated  tumors  ranging  in  size  from  a  flaxseed  to  a  cherry,  and 
between  these  were  hyaline  miliary  tubercles.  The  lungs  showed 
main"  grayish  tubercles,  and  the  pericardium  ^vas  covered  with  them. 
The  mesentery  contained  countless  small  tumors,  many  of  them 
pedunculated.  The  capsule  of  the  spleen  was  studded,  and  the  liver 
showed  numerous  miliary  tubercles  in  its  pulp  and  on  its  capsule. 
Each  kidney  bore  5  or  6  grayish  tubercles  the  size  of  ilaxseed  upon 
its  outer  surface.  The  virulence  of  the  germs  isolated  from  this  calf 
was  further  proven  by  inoculations  upon  the  guinea  pig.  The  author 
thinks  that  it  is  here  proven  that  pearl  disease  of  cattle  may  appear 
in  man. 

Nocard 46  states  that  cattle  are  not  refractory  to  human  tubercu- 
losis and  that  it  is  easy  to  give  the  proof  of  this.  If  they  are  inocu- 
lated in  the  arachnoid  cavity  with  a  few  drops  of  a  feeble  culture  of 
the  human  bacillus  the}' succumb  in  less  than  a  month,  and  the  autopsy 
reveals  lesions  of  tuberculous  meningitis  absolutely  identical  with 
those  of  children.  A  calf  5  months  old  inoculated  in  this  way  August 
2  succumbed  August  28.  A  portion  of  its  pia  mater,  infiltrated  with 
tubercles,  killed  in  6  weeks  the  guinea  pig  which  received  it  in  the 
peritoneum. 

Arloing47  reports  experiments  with  three  different  cultures  of 
human  origin.  One  of  these  had  been  in  his  laboratory  since  1896. 
It  was  capable  of  infecting  guinea  pigs  and  rabbits  by  subcutaneous 
inoculation.  He  inoculated  by  intravenous  injection  with  an  emulsion 
of  this  culture  a  heifer,  a  young  calf,  2  sheep,  and  a  kid.  He  says 
that  on  autopsy  the  calf  and  the  sheep  presented  a  superb  eruption  of 
tuberculous  granulations  in  all  parts  of  the  lung,  principally  in  the 
anterior  lobe.  With  the  kid  the  lesions  were  more  diffuse,  and  so 
extensive  that  the  lungs  scarcely  collapsed  when  removed  from  the 
thorax.  The  heifer  showed  signs  of  pleural  disease,  for  very  marked 
excrescences  were  found  on  the  borders  of  the  lung  and  on  their  dia- 
phragmatic surface.  A  small  number  of  tubercles  were  found  scat- 
tered through  the  lung.  With  the  second  culture  he  inoculated 
intravenously  a  calf,  2  sheep,  and  a  goat.  The  autopsy  demonstrated 
the  existence  of  tuberculosis  of  the  lungs  in  all  of  these  animals. 
With  the  calf  there  were  found  a  multitude  of  small  young  tubercles, 
and  the  subpleural  granulations  slightly  raised  in  the  serous  mem- 
brane were  easily  seen.  With  the  sheep  the  lungs  had  but  little  ten- 
dency to  collapse.  There  were  many  subpleural  granulations  and 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  43 

small  tubercles  throughout  the  parenchyma.  With  the  goat  the 
lesions  recalled  those  found  with  the  sheep,  but  were  less  confluent. 
With  an  emulsion  of  the  third  culture  he  inoculated  a  vounpf  bull, 

*.  o 

2  sheep,  and  a  goat  by  intravenous  injection.  The  bull  died  at  the 
end  of  32  days.  It  was  considerably  emaciated,  having  lost  35  kilo- 
grams. The  anterior  and  median  lobes  of  the  two  lungs  were  studded 
with  tubercles  of  various  sizes,  the  largest  being  the  size  of  a  millet 
seed.  The  bronchial  and  esophageal  glands  were  enormous,  weighing 
400  grams.  In  the  lungs  of  the  sheep  there  were  perceived  by  the 
touch  an  enormous  number  of  small  subpleural  tubercles.  On  sec- 
tion there  were  also  seen  man}'  tuberculous  granulations  in  the  depth 
of  the  parenchyma.  With  the  goat  the  lesions  were  similar  to  those 
found  in  the  sheep,  except  the  granulations  were  smaller. 

Behring48  reports  an  experiment  in  which  human  sputum  was  in- 
jected into  a  guinea  pig  and  a  culture  from  this  animal's  spleen  was 
used  for  inoculating  a  goat.  An  emulsion  of  the  spleen  of  the  goat 
was  passed  through  a  series  of  guinea  pigs,  and  a  culture  obtained 
from  the  spleen  of  the  third  guinea  pig  was  inoculated  into  a  calf  bv 
intravenous  injection.  The  calf  died  after  4  weeks,  directly  from  the 
tuberculosis  thus  produced.  At  the  autopsy  the  lungs  were  found  in 
the  red  stage  of  hepatization.  From  these  organs  tubercle  bacilli  were 
recovered  in  large  numbers.  A  fairly  numerous  collection  of  sub- 
pleural nodules  were  present,  which  were  yellowish  in  color  and  had 
reached  in  some  instances  the  size  of  peas.  Tubercle  bacilli  were 
recovered  readily  from  these  nodules.  The  bronchial  glands  were 
swollen  and  tubercle  bacilli  were  proven  present  within  them.  The 
liver  contained  fatty  infiltrations,  and  the  spleen  was  darkened,  hut 
scarcely  enlarged.  Tubercle  bacilli  were  recovered  from  it.  but  were 
not  numerous.  The  pronounced  malignity  of  the  virus  in  this  instance 
is  worthy  of  particular  notice,  because  it  concerns  bacilli  derived  from 
human  sputum,  although  they  had  been  passed  through  the  goat.  A 
cow  was  also  inoculated  with  a  tuberculosis  culture  of  human  origin 
after  a  single  passage  through  a  guinea  pig.  The  inoculation  was 
made  intraocularly  on  November  2»>,  1JM)1.  On  January  14.  1!»02,  the 
affected  eye  was  enucleated  and  a  pure  culture  was  obtained  from  it 
after  one  passage  through  a  guinea  pig.  The  cow  did  not  die  at  once 
as  a  result  of  the  inoculation,  but  has  been  gradually  losing  ground, 
and  was  at  the  time  the  report  was  made  in  a  condition  of  chronic 
disease  so  serious  that  the  final  outcome  could  not  be  foretold. 

Dean  and  Todd.<u  who  have  recently  carried  out  certain  experi- 
ments to  ascertain  whether  the  tubercle  bacillus  of  human  origin 
undergoes  any  marked  change  in  virulence  for  the  bovine  sjx'eies  by 
passage  through  certain  other  animals,  say  that  "the  experiments 
show  that  the  human  tubercle  bacillus  Is  by  no  means  innocuous  to  the 
calf,  as  the  control  animal  injected  directly  with  sputum  contracted  an 


44  BUREAU    OF    ANIMAL    INDUSTRY. 

extensive  glandular  tuberculosis;"  also,  "'as  mentioned  above,  with 
reference  to  the  infection  of  the  pig,  an  important  result  was  obtained, 
as  the  experiments  conclusively  prove  that  this  animal  is  capable  of 
contracting  a  rapidly  fatal  general  tuberculosis  as  the  result  of  inocu- 
lation with  the  tubercle  bacillus  of  human  origin." 

These  investigations  are  now  sufficiently  numerous  and  sufficiently 
harmonious  in  their  results  to  establish  the  following  conclusions: 

(1)  The  bacillus  tuberculosis  found  in  human  tuberculosis  differs 
greatly  in  its  pathogenic  powers  as  obtained  from  different  cases. 

(2)  Two  types  of  tubercle  bacilli  may  be  obtained  from  man,  namely, 
one  which  is  somewhat  difficult  to  cultivate,  which  grows  slowly,  and 
the  bacilli  of  which  are  short,  stubby,  and  free  from  beading — the 
so-called  bovine  type;  and  a  second,  which  is  quite  easily  cultivated, 
grows  rapidly,  is  longer,  thinner,  and  inclined  to  show  beaded  and 
curved  forms — the  so-called  human  type. 

(3)  Virulent  cultures  may  be  obtained  from  both  of  these  types, 
which,  when  inoculated  according  to  the  methods  used  by  Koch  and 
upon  the  species  of  animals  specified  by  him,  produce  progressive  and 
fatal  tuberculosis. 

(4)  The  contention  that  human  tuberculosis  can  not  be  transmitted 
to  asses,  sheep,  goats,  hogs,  and  especially  to  cattle,  has  been  com- 
pletely disproved. 

(5)  Koch's  failure  to  produce  tuberculosis  in  the  animals  named 
with  bacilli  from  human  sources  was  probably  due  to  the  use  of  bacilli 
of  low  pathogenic  power. 

THE    TRANSMISSION    OF   BOVINE    TUBERCULOSIS   TO   MAN. 

Some  interesting  observations  have  also  been  made  during  the 
year  with  reference  to  the  transmission  of  bovine  tuberculosis  to  man. 
Krause  reports  the  case  of  a  laborer  who  was  brought  to  the  clinic  in 
order  to  ascertain  whether  the  trouble  in  his  right  arm  was  due  to 
infection,  and,  if  so,  of  how  long  standing.  The  man  stated  that  he 
was  a  butcher,  whose  duty  it  was  to  remove  the  diseased  parts  of  cattle 
killed  for  food.  Three  3'ears  previously  he  ran  a  splinter  of  wood  from 
a  table  into  his  right  thumb,  and  immediately  afterwards  removed  the 
hide  from  a  cow  that  had  been  sick.  Soon  his  arm  swelled  and  pained 
him;  later  it  was  covered  with  discharging  ulcers  of  various  sizes. 
Incisions  were  made  in  the  arm,  but  without  causing  complete  healing; 
afterwards  larger  incisions  were  made,  which  were  successful.  Pieces 
of  gland  and  skin  from  the  arm  proved  on  examination  to  be  tuber- 
culous. According  to  the  man's  statement,  he  is  of  a  healthy  family, 
30  years  old,  and  had  not  previously  suffered  from  disease.  The  lungs 
were  sound,  as  were  all  the  other  internal  organs,  and  his  mind  was 
clear.  The  reporter  thinks  there  is  no  doubt  whatever  that  this  was 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  45 

a  case  of  inoculation  tuberculosis  traceable  directly  to  the  splinter 
wound  on  the  thumb. 

llavenel >0  reported,  in  his  address  at  the  British  Congress  on 
Tuberculosis,  the  case  of  his  assistant,  who  was  inoculated  with  bovine 
tuberculosis,  and  from  whose  tissues  bacilli  were  recovered  after  58 
days  which  retained  the  activity  of  the  original  bovine  virus. 

Quite  recently  Spronck  and  Hoefnagel51  recorded  the  following 
case:  In  May,  1900,  a  veterinarian  accidentally  wounded  with  a  knife 
the  finger  of  a  butcher  who  was  assisting  him  in  inspecting  the  tubercu- 
lous organs  of  a  cow.  The  wound  healed  promptly,  but  was  followed 
in  a  few  da>'S  by  tumefaction  and  the  formation  of  cracks  in  the  skin. 
The  skin  of  the  finger  became  thickened  and  blue  in  color  and  the 
cracks  covered  with  little  scabs.  In  February,  Professor  Nareth  extir- 
pated the  affected  portion  of  the  skin,  together  with  the  tumefied 
cubital  ganglia.  The  tuberculous  nature  of  the  cutaneous  lesions, 
as  well  as  that  of  the  hypertrophied  ganglia,  was  easily  recognized 
both  b}r  microscopic  examination  and  by  the  inoculation  of  guinea 
pigs.  A  calf  previously  tested  with  tuberculin  was  placed  in  a  newly 
constructed  stable,  in  which  no  animal  had  been  kept,  and  inoculated 
with  an  emulsion  made  from  the  spleen  of  one  of  these  guinea  pigs. 
Five  days  after  the  inoculation  a  swelling  was  noticed,  and  in  a  few 
days  the  superficial  cervical  ganglia  were  visibly  tumefied.  The 
animal  soon  exhibited  constitutional  s}Tmptoms,  remained  lying  down 
most  of  the  time,  and  drank  excessively.  The  swelling  increased 
rapidly  and  the  animal  was  slaughtered  57  days  after  the  inocula- 
tion. At  the  autopsy  there  was  found  at  the  point  of  inoculation  on 
the  right  side  of  the  neck  a  tuberculous  granuloma  the  si/e  of  a 
fist  inclosing  at  its  center  a  large  cavity  filled  with  a  soft,  cheesy 
mass.  The  neighboring  superficial  ganglia  were  found  granuloma- 
tous,  hypertrophied,  and  hard.  The  pleura  and  the  visceral  folds 
presented  numerous  tubercles,  varying  in  diameter  from  1  to  <>  mm. 
The  tissue  of  the  lungs  was  also  the  seat  of  numerous  tubercles  of 
similar  size,  each  showing  an  inflammatory  arcola.  The  bronchial 
and  rnediastinal  glands  were  hypertrophied,  and  on  section  showed 
caseous,  noncalcified  contents.  Similar  conditions  were  found  in  the 
organs  generally  throughout  the  body.  Microscopic  examination 
demonstrated  that  the  tuberculous  foci  contained  abundant  giant 
cells  and  numerous  tubercle  bacilli.  Finally,  '2  guinea  pigs  which 
had  been  inoculated  with  material  from  the  hypertrophied  cervical 
ganglia— i  in  the  peritoneum  and  the  other  beneath  the  skin — died  of 
tuberculosis.  The  bacilli  had  consequently  retained  their  virulence 
for  a  period  of  2<>  months,  during  which  they  lived  in  human  tissues. 
These  observations,  according  to  the  authors,  leave  no  doubt  as  to  the 
possibility  of  the  infection  of  man  with  bovine  tuberculosis,  and  they 


40  BUREAU  OF  ANIMAL  INDUSTRY. 

hold  that  cases  of  contagion  from  the  use  of  milk,  butter,  and  meat  of 
tuberculous  cattle  are  not  so  rare  as  Koch  and  Baumgarten  maintain. 

Lassar5'  was  impelled  by  Koch's  statements  to  examine  closely  the 
records  of  his  patients  during  the  past  decade  to  determine  how  mairy 
of  those  that  were  suffering  from  verrucose  tuberculosis  of  the  skin 
of  the  hands  could  have  been  infected  by  means  of  injuries  received 
in  handling  tuberculous  meats.  He  found  34  cases  of  tuberculosis 
following  wounds  in  108,000  patients,  but  only  4  of  this  number 
were  butchers.  He  later  questioned  and  examined  365  men  who  were 
employed  in  abattoirs,  and  found  7  suffering  from  inoculated  tuber- 
culosis, while  3  others  must  be  considered  as  possibly  affected.  This 
shows  '2  to  3  cases  to  each  100  men  employed  in  the  abattoirs,  and 
only  one-third  of  1  per  1.000  among  persons  otherwise  employed. 

HiiLs53  reports  a  case  of  a  miller's  family  in  good  circumstances 
near  Manderschied,  composed  of  the  miller,  his  wife,  five  sons,  and  two 
daughters,  all  herculean  in  stature  and  boastful  of  strength  and  health. 
Consumption  had  never  occurred  in  the  families  of  either  of  the  par- 
ents. The  mother  became  affected  with  pulmonary  catarrh,  wrhich 
aroused  a  suspicion  of  tuberculosis,  but  after  a  few  months  she  was 
again  healthy.  During  the  following  year  the  13-year-old  daughter 
became  ill  of  pulmonary  tuberculosis  and  died.  The  same  year  an 
18-year-old  son  died,  and  the  following  year  a  23-year-old  son.  Two 
years  after  her  first  illness  the  mother  sickened  and  died;  then  followed 
the  death  of  a  16-year-old  daughter,  then  the  father,  and  finally  the 
third  son,  all  of  pulmonary  tuberculosis.  For  one  of  the  two  remain- 
ing sons  a  tuberculous  abscess  of  the  finger  was  treated,  which  healed. 
These  two  men  are  still  living.  Hills  thinks  that  the  view  of  contagion 
from  the  sick  members  of  the  family  can  not  be  held,  since  there  was 
practically  no  contact.  These  cases  appeared  subsequently  to  the  intro- 
duction by  the  miller  of  a  herd  of  Simmenthal  cattle  on  his  farm.  These 
cattle  were  all  practically  infected  with  tuberculosis,  and  it  was  scarcely 
possible  to  dispose  of  the  meat  on  account  of  its  infected  condition. 
Many  of  the  carcasses  were  returned  on  account  of  being  tuberculous, 
so  that  later  the  owner  was  compelled  to  sell  the  cattle  without  a 
guaranty  as  to  their  condition. 

Considering  these  facts,  in  connection  with  those  of  similar  bearing 
previously  reported,  it  may  be  said  that  the  transmission  of  bovine 
tuberculosis  to  man  is  fairly  well  established.  The  apparent  inocula- 
tion of  a  human  subject  writh  bovine  tubercular  material,  the  develop- 
ment of  a  tubercular  process  at  the  point  of  inoculation,  the  isolation 
from  the  human  tissues  months  afterwards  of  a  tubercle  bacillus  hav- 
ing the  characteristics  of  the  bovine  bacillus,  constitute  a  chain  of 
evidence  that  is  conclusive. 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  47 

INVESTIGATIONS    BEARING    UPON    INTESTINAL    INFECTION. 

Heller54  has  made  an  investigation  as  to  the  comparative  frequency 
of  primary  intestinal  tuberculosis.  He  says  that  it  is  well  known  that 
tuberculosis  frequently  appears  after  diphtheria,  and  he  therefore 
investigated  to  determine  first  how  often  tuberculosis  was  present 
before  the  attack  of  diphtheria,  and,  second,  how  often  the  primary 
lesions  were  located  in  the  intestine. 

Sections  were  made  from  714  victims  of  diphtheria,  and  among 
these  140,  or  19.6  per  cent,  were  found  to  have  an  associated  affection 
of  tuberculosis  in  various  organs. 

2,  or    1.43  per  cent,  showed  primary  intestinal  tuberculosis. 

8,  or    5.7    per  cent,  showed  primary  intestinal  and  mesenteric  gland 

tuberculosis. 
33,  or  23.5    per  cent,  showed  primary  mesenteric  gland  tuberculosis. 

43,  or  30.7    per  cent,  of  all  the  tuberculosis  cases. 


43,  or    6       per  cent,  of  all  the  diphtheria  cases. 
10,  or    7.1    percent,  had  mesenteric  gland  tuberculosis,  with  affec- 
tion of  other  abdominal  organs. 

53,  or  37.8    per  cent,  of  all  tuberculosis  cases. 
53,  or    7.4    per  cent,  of  all  diphtheria  cases. 

In  addition  to  these,  there  were  6  other  cases  affected  with  tuber- 
culosis of  the  intestines  or  of  the  mesenteric  glands,  together  with  a 
tubercular  affection  of  the  lungs. 

With  30.7  per  cent  of  so  many  tuberculosis  cases  showing  primary 
lesions  in  the  intestines  or  mesenteric  glands,  the  argument  against 
infection  by  ingestion  of  tuberculous  food  which  was  raised  by  Koch 
and  based  upon  German  statistics  appears  to  be  greatly  weakened. 

Gottstein,55  in  a  recent  statistical  study  relative  to  the  etiology  of 
tuberculosis,  concludes  that  among  children  in  Berlin  the  mortality  of 
those  at  the  breast  is  but  slightly  more  than  half  as  much  from  tuber- 
culosis as  among  those  otherwise  nourished,  the  proportion,  as  he  finds 
it,  being  as  6  to  10.  He  also  finds,  in  studying  the  statistics  of  23 
large  cities  and  university  cities,  where  the  returns  are  especially 
reliable,  that  whereas  there  has  been  a  reduction  of  the  mortality  at 
all  ages  from  tuberculosis,  this  reduction  has  been  distinctly  less  in 
children  under  15  years  of  age  than  in  persons  over  that  age.  From 
this  he  concludes  that  "the  thought  is  not  to  be  set  aside  that  in  the 
etiology  of  tuberculosis  in  children  and  in  grown  people  very  important 
differences  must  occur.  There  must  be  assumed  for  the  infection  of 
children  another  source  than  for  that  of  grown  people,  and  it  certainly 
is  natural  to  conclude  from  the  difference  established  statistically  that 
the  source  of  children's  tuberculosis  is  to  be  sought  partly  in  nourish- 
ment with  milk  containing  tubercle  bacilli,  while  the  decrease  since 


48  BUREAU    OF    ANIMAL    INDUSTRY . 

1894  is  to  be  traced  back  to  the  better  general  and  individual  prophy- 
laxis in  the  care  of  milk." 

An  examination  of  the  vital  statistics  of  Massachusetts  and  Michi- 
gan, the  only  States  from  which  sufficiently  complete  records  were 
received,  indicates  a  tendency  of  the  same  nature  in  the  development 
of  tuberculosis  in  the  United  States.  In  the  Vital  Statistics  of  Mas- 
sachusetts, 1853-1895,  the  2  years  1856-1857  are  contrasted  with  the 
2  }Tears  1894—1895.  In  the  2  years  first  mentioned,  for  the  period 
under  5  years  of  age,  there  were  46.3  deaths  from  pulmonary  phthisis 
to  1,000  deaths  from  all  causes.  In  the  2  years  last  mentioned  there 
were  but  15.6  deaths  from  pulmonary  phthisis  to  1,000  deaths  from  all 
causes,  or  one-third  as  many.  This  is  a  very  gratifying  reduction  in 
the  phthisis  death  rate.  Let  us  see,  now,  how  it  is  with  other  forms 
of  tuberculosis.  In  the  2  years  first  mentioned  there  were  in  the  same 
age  class  70.7  deaths  from  other  forms  of  tuberculosis  to  each  1,000 
deaths  from  all  causes;  and  in  the  2  }Tears  last  mentioned  there  were 
96.2  deaths  from  other  forms  of  tuberculosis  to  each  1,000  deaths 
from  all  causes.  That  is,  in  this  40  years  there  appears  to  have  been 
an  increase  of  36  per  cent  in  the  forms  of  tuberculosis  other  than 
phthisis  in  the  class  under  5  years  of  age,  while  there  was  a  reduction 
in  the  mortality  of  phthisis  at  all  ages  of  about  45  per  cent.  The  vital 
statistics  of  Michigan  show  that  in  that  State  during  the  years  1870 
to  1884,  inclusive,  taking  the  class  under  5  years  of  age,  there  were  for 
each  100  deaths  from  consumption  81.8  deaths  from  other  forms  of 
tuberculosis;  during  the  years  1885  to  1897,  inclusive,  there  were  104.3 
deaths  from  other  forms  of  tuberculosis  to  each  100  from  consump- 
tion, while  during  the  3  y ears  1898  to  1900,  inclusive,  there  were  263.3 
deaths  from  other  forms  of  tuberculosis  to  each  100  from  consump- 
tion. Why  this  tremendous  increase  in  mortality  from  other  forms 
of  tuberculosis  as  compared  with  consumption  at  what  has  well  been 
called  the  milk-drinking  age  of  life? 

Another  important  question  which  was  discussed  by  your  committee 
in  its  last  report  has  reference  to  the  possibility  and  frequency  of 
tubercular  infection  through  contaminated  food  when  the  primary 
lesions  are  elsewhere  than  in  the  abdominal  cavity.  The  frequency 
with  which  infection  may  occur  through  the  walls  of  the  upper  air 
passages,  and  particularly  those  of  the  nasopharynx  and  pharynx, 
was  shown.  From  recent  experiments  it  appears  that  there  is  very 
likely  another  channel  by  which  such  infection  may  readily  occur.  It 
is  a  common  observation  that  tubercle  bacilli  ma}T  penetrate  the  intes- 
tine and  produce  tubercles  in  the  mesenteric  glands  without  causing 
any  lesions  at  the  point  where  they  pass  through  the  intestinal  wall. 
It  has  been  frequently  held,  however,  that  they  could  not  enter  the 
thoracic  duct  and  the  blood  vessels  without  first  passing  through  and 
being  arrested  by  a  lymphatic  gland. 


BOVINE    TUBERCULOSIS    AND   PUBLIC    HEALTH.  49 

Dobroklonski 56  in  1S90  conducted  some  investigations  from  which 
he  concluded  that  tuberculosis  may  certainly  affect  the  organism  by 
the  digestive  tract.  For  this  infection  to  occur  it  is  not  necessary 
that  there  should  exist  a  lesion  of  the  intestinal  wall,  an  epithelial 
desquamation,  nor  any  local  modification  whatever,  nor  an  interior 
inflammatory  process.  The  tubercular  virus  (bacilli  as  well  as  spores) 
may  easily  traverse  the  completely  normal  epithelial  lining  of  the 
intestine.  The  tubercle  bacilli  as  well  as  their  spores,  unless  they 
remain  a  long  time  in  contact  with  the  intestinal  wall,  are  not  capable 
of  causing  inflammatory  processes  in  this  wall,  nor  modifications  of 
the  epithelial  coat. 

In  1895,  Desoubiy  and  Porcher57  made  investigations  with  dogs  to 
learn  if  microbes  of  various  kinds  may  pass  through  the  intestinal  wall 
and  enter  the  thoracic  duct.  They  took  chyle  directly  from  the  cistern 
of  Pecquet,  and  also  blood  from  the  portal  vein.  In  both  cases  they 
demonstrated  the  presence  of  bacteria.  The  species  were  not  deter- 
mined, but  they  observed  cocci,  bacteria,  and  bacilli.  They  say,  in  con- 
clusion, that  it  seems  to  follow  from  their  experiments  that  microbes 
may  follow  the  lumen  of  the  chyle  vessels.  Every  time  that  the  ani- 
mal received  either  fat  or  milk  they  constantly  found  bacterial  species 
in  the  chyle.  They  ask,  Afciy  we  not  infer  from  this  that  the  microbes 
pass  into  the  chyle  vessels  by  means  of  the  globules  of  fat '. 

Quite  recently  Nicolas  and  Descos58  have  experimented  in  a  similar 
manner  after  feeding  tubercle  bacilli  to  dogs.  These  investigators  fed 
a  soup  composed  of  from  1  to  1£  liters  of  milk,  according  to  the  size 
of  the  animal,  from  80  to  100  grams  of  fat,  and  about  Loo  grams  of 
bread  to  dogs  which  had  fasted  '24  to  3(5  hours.  The  animals  were 
killed  from  3  to  3i  hours  later.  The  chyle  for  examination  was  taken 
from  the  cistern  of  Pecquet  or  the  thoracic  duct.  After  each  experi- 
ment a  complete  autopsy  was  made  to  assure  the  authors  that  the  ani- 
mal did  not  possess  any  tuberculous  lesion  and  that  the  intestine  was 
perfectly  normal.  The  presence  of  tubercle  bacilli  was  demonstrated 
by  the  coloration  of  the  microscopic  preparations  and  by  the  inocula- 
tion of  guinea  pigs.  Positive  results  were  obtained  by  both  methods. 
The  authors  conclude  as  follows:  The  essential  fact  brought  out  by 
these  experiments  is  that  3  hours  after  the  ingestionof  tubercle  bacilli 
the  chyle  and  the  lymph  of  the  thoracic  duct  may  contain  bacilli  and 
even  virulent  bacilli  in  a  sufficient  number  to  cause  tuberculosis  in  the 
guinea  pig.  They  think  it  quite  interesting  to  know  that  this  may 
occur  under  conditions  which  approach  quite  closely  those  of  a  child 
fed  with  tuberculous  milk. 

To  recapitulate,  recent  investigations  show  that— 

(L)  While  the  bacilli  of  human  tuberculosis  are  often  of  feeble  viru- 
lence for  cattle,  there  is  a  considerable  proportion  of  cases  in  which 
these  bacilli  are  virulent  for  cattle  as  well  as  other  animals. 

13110— Xo.  53—04 4 


50  BUREAU  OF  ANIMAL  INDUSTRY. 

(•2)  Bacilli  of  both  the  bovine  type  and  the  human  type  have  been 
obtained  from  cases  of  human  tuberculosis. 

(3)  Bovine  bacilli  introduced  into  the  human  tissues  by  accidental 
inoculation  have  lived,  multiplied,  and  produced  disease  at  the  point 
of  inoculation,  and  have  been  recovered  after  a  considerable  time 
with  their  vitality  and  virulence  unimpaired. 

(4)  Various  statistical  studies  indicate  that  a  considerable  propor- 
tion of  the  cases  of  human  tuberculosis,  and  particularly  with  chil- 
dren, originate  through  the  ingestion  of  the  bacilli  with  contaminated 
food. 

It  appears  to  your  committee,  therefore,  that  the  conclusions  of 
Koch,  announced  at  the  British  Congress  on  Tuberculosis,  to  the 
effect  that  bovine  and  human  tuberculosis  are  different,  that  human 
tuberculosis  can  not  be  conveyed  to  cattle,  and  that  man  is  insuscep- 
tible to  bovine  tuberculosis  are  disproved  and  should  no  longer  have 
weight  with  sanitarians.  The  evidence  brought  forward  indicates 
that  greater  care  should  be  exercised  to  prevent  human  infection  with 
bovine  tuberculosis,  and  particularly  to  guard  children  from  tubercu- 
lous milk. 


BOTINE  TUBERCULOSIS  AFFECTING  THE   PUBLIC 
HEALTH.     (Third  report.)' 

By  D.  E.  SALMON,  D.  V.  M., 

Chief  of  the  Bureau  of  Animal  Industry  and  Chairman  of  the  Committee  ou  Animal 
Diseases  and  Animal  Food  of  the  American  Puhlic  Health  Association. 

Your  committee  on  animal  diseases  and  animal  food  have  the  honor 
to  make  the  following  report  with  reference  to  tuberculosis,  and 
regret  that  the  time  at  the  chairman's  disposal  has  not  permitted  the 
inclusion  of  other  subjects  which  are  also  of  great  interest  at  this 
time. 

In  the  last  two  reports  presented  by  this  committee  considerable 
space  was  devoted  to  the  subject  of  tuberculosis,  and  particularly  to 
that  phase  of  it  which  relates  to  the  transmission  of  the  disease  from 
animals  to  man.  It  was  shown  from  a  review  of  the  facts  obtained  by 
different  methods  of  inquiry  that  the  clinical  evidence,  the  evidence  of 
statistics,  and  the  evidence  from  experimental  researches  all  favored 
the  conclusion  that  animal  tuberculosis  was  a  factor  in  the  causation 
of  human  tuberculosis,  and  it  was  held  that  sanitarians  should  advo- 
cate and  enforce  measures  to  prevent  the  transmission  of  the  disease 
from  animals  to  man.  This  question  is  so  important  and  so  much 
uncertainty  has  been  caused  by  the  paper  presented  at  the  British 
Congress  on  Tuberculosis  by  Koch,2  and  by  his  subsequent  address 
at  the  International  Conference  on  Tuberculosis  at  Berlin,59  that  it  is 
deemed  advisable  to  continue  the  discussion  in  the  present  report. 

The  fact  that  tubercular  material  from  human  subjects  often  failed 
to  produce  serious  disease  in  cattle  was  observed  by  a  number  of  the 
earlier  investigators  who  experimented  with  such  virus.  It  was  the 
experiments  and  comparative  studies  of  Theobald  Smith,  however, 
which  attracted  special  attention  to  the  difference  in  virulence  shown 
by  tubercle  bacilli  from  human  and  bovine  sources  when  inoculated 
upon  cattle.  Smith60  mentioned  also  certain  morphological  and  cul- 
tural differences  in  bacilli  from  these  two  sources,  and  in  tin1  location 
and  histology  of  the  lesions  in  cattle  produced  by  such  bacilli.  lie 
did  not  conclude,  however,  that  bovine  bacilli  could  not  produce  dis- 
ease in  the  human  subject,  but  said: 

It  seems  to  inn  that,  accepting  the  clinical  evidence-  on  hand,  hovine  tuberculosis 
may  l>e  transmitted  to  children  when  the  body  is  overpowered  by  large  nnmlx'rs  of 
bacilli,  as  in  ndder  tlitiercillofUH,  or  when  certain  unknown  favorable  conditions 
exist. 


"Report  of  committee  on  animal  diseases  and  animal   food  to  the  American  Public 
Health  Association,  at  Washington,  I).  C.,  October  !'(>-:{(),  l!Ht:{. 

51 


52  BUREAU  OF  ANIMAL  INDUSTRY. 

Koch,  however,  in  his  address  at  the  British  Congress  on  Tubercu- 
losis, went  far  beyond  this  and  maintained  that  "human  tuberculosis 
differs  from  bovine,  and  can  not  be  transmitted  to  cattle."  As  to  the 
susceptibility  of  man  to  bovine  tuberculosis,  he  said  it  was  not  yet 
absolutely  decided,  but  one  was  "nevertheless  already  at  liberty  to  say 
thai,  if  such  a  susceptibility  really  exists,  the  infection  of  human 
beings  is  but  a  very  rare  occurrence."  He  emphasized  this  view  in 
the  following  language: 

I  should  estimate  the  extent  of  infection  by  the  milk  and  flesh  of  tubercular  cattle 
and  the  butter  made  <  if  their  milk  as  hardly  greater  than  that  of  hereditary  trans- 
mission, and  I  therefore  do  not  deem  it  advisable  to  take  any  measures  against  it. 

This  conclusion  wras  so  radically  different  from  the  views  of  most 
experimenters  and  so  out  of  harmony  with  facts  which  had  apparently 
been  demonstrated  by  others,  that  it  at  once  aroused  opposition  in  the 
congress,  followed  by  the  adoption  of  dissenting  resolutions,  and  led 
to  numerous  investigations  in  various  countries.  Koch's  conclusions 
\vere  based  upon  his  failure  to  produce  tuberculosis  in  cattle  and  other 
animals  by  inoculating  them  with  tubercular  material  of  human  origin, 
and  his  success  in  causing  progressive  and  fatal  tuberculosis  in  the 
same  kinds  of  animals  wThen  inoculated  with  tubercular  material  of 
bovine  origin.  With  such  positiveness  did  he  hold  to  the  constant 
and  specific  difference  between  the  human  and  bovine  bacillus  that  he 
promulgated  an  experimental  method  of  discriminating  between  them. 
Speaking  of  the  etiology  of  intestinal  tuberculosis  in  man,  he  said: 

Hitherto  nobody  could  decide  with  certainty  in  such  a  case  whether  the  tubercu- 
losis of  the  intestine  was  of  human  or  of  animal  origin.  Now  we  can  diagnose  them. 
All  that  is  necessary  is  to  cultivate  in  pure  culture  the  tubercle  bacilli  found  in  the 
tubercular  material,  and  to  ascertain  whether  they  belong  to  bovine  tuberculosis  by 
inoculating  cattle  with  them.  For  this  purpose  I  recommend  subcutaneous  injection, 
which  yields  quite  specially  characteristic  and  convincing  results. 

These  important  and  comprehensive  conclusions  followed  from  a 
comparatively  few7  experiments  upon  animals,  and  apparently  no  effort 
had  been  made  to  learn  to  what  extent  human  tubercle  bacilli  might 
differ  in  their  virulence  for  cattle  or  what  grades  of  virulence  there 
might  be  among  bacilli  of  bovine  origin.  Vagedes  had  already  shown 
that  bacilli  were  sometimes  present  in  human  lesions  which  were  as 
virulent  as  bovine  bacilli,  but  his  work  was  wholly  ignored  by  Koch. 
In  the  preceding  report  of  this  committee  reference  was  made  to  the 
work  of  Ravenel,  de  Schweinitz,  Mohler,  De  Jong,  Delepine,  Orth, 
Stenstrom,  Fibiger  and  Jensen,  Max  Wolff,  Nocard,  Arloing,  Behring, 
and  Dean  and  Todd,  all  of  whom  found  tubercle  bacilli  in  human 
lesions  which  proved  to  have  about  the  same  virulence  for  cattle  and 
other  animals  as  had  the  bacilli  from  bovine  animals  affected  with 
tuberculosis.  Since  that  report  was  presented,  Theobald  Smith  has 
reported  the  finding  of  a  human  bacillus  virulent  for  cattle,  and  there 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  53 

has  been  made  a  preliminary  announcement  by  Kossel  of  the  results 
obtained  by  the  German  tuberculosis  commission.  The  statement  of 
Kossel  should  receive  the  most  careful  consideration,  coming  from  a 
commission  appointed  upon  Koch's  recommendation,  and  evidently 
inclined  to  favor  his  views  so  far  as  possible  in  its  report. 

Kossel61  stated  that  the  commission  had  tested  7  cultures  of  tuber- 
culosis from  cattle  and  hogs — 4  from  cattle  and  3  from  hogs.  Two  of 
these  cultures  proved  acutely  fatal  in  cattle  after  8  to  9  weeks;  4  of 
the  cultures  likewise  produced  a  generalized  tuberculosis,  but  which 
certainly  had  a  more  chronic  course;  while  1  of  the  cultures  caused 
only  an  infiltration  at  the  point  of  inoculation,  with  some  caseous  foci 
in  the  adjoining  prescapular  gland  and  in  one  of  the  mediastinal 
glands,  and  there  was  lacking  th -}  spreading  of  the  tuberculosis  over 
the  entire  body,  which  they  were  accustomed  to  see  aft  >r  the  injection 
of  cultures  of  bovine  tuberculosis.  "  Hence."  says  Kossel,  "among 
bovine  tuberculosis  bacilli  there  can  also  occur  differences  with  regard 
to  the  virulence." 

The  German  commission  also  tested  35>  different  freshly  made 
cultures  from  tuberculous  disease  in  man.  Nineteen  of  these  cultures 
did  not  produce  the  slightest  symptoms  in  cattle;  with  i)  others  the 
cattle  exhibited  after  4  months  very  minute  foci  in  the  prescapular 
glands,  which  were  mostly  encapsuled  and  showed  no  inclination  to 
progress;  with  T  other  cases  there  was  somewhat  more  marked  disease 
of  the  prescapular  glands,  but  it  did  not  go  so  far  as  a  material  spread- 
ing of  the  process  to  the  glands  next  adjoining:  there  were  4  cultures, 
however,  which  were  more  virulent  and  caused  generalized  tubercu- 
losis in  the  cattle  inoculated  with  them. 

It  would  appear,  therefore,  that  hereafter  even  Koch  must  admit 
that  it  is  impossible  always  to  tell  the  source  of  a  culture  of  the 
tubercle  bacillus  by  its  effects  when  it  is  inoculated  upon  cattle.  One 
of  the  bovine  cultures  failed  to  produce1  generalized  tuberculosis  in 
cattle,  and  some  of  the  human  cultures  did  produce  this  form  of  the 
disease  in  such  animals.  Moreover,  while  some  of  the  human  cultures 
caused  no  disease  at  all,  others  led  to  the  development  of  minute  foci 
in  the  prescapular  glands,  and  still  others  to  somewhat  more  marked 
disease  of  these  glands.  There  were,  consequently,  four  degrees  of 
virulence  noted  in  these  35*  cultures  of  bacilli  from  human  sources  and 
three  degrees  of  virulence  in  the  7  cultures  from  animal  sources. 

Now,  if  we  accept  the  views  of  Koch  as  to  the  specific  difference 
between  human  and  bovine  tubercle  bacilli,  and  that  the  human  bacilli 
produce  only  localized  lesions  in  cattle,  while  bovine  bacilli  produce 
generalized  lesions  in  these  animals,  must  we  not  conclude  that  the  one 
nonvirulent  bovine  culture  was  in  reality  of  human  origin,  and  that 
the  animal  from  which  it  was  obtained  had  been  infected  from  man? 
This  is  a  logical  deduction,  but  reverses  the  dictum  laid  down  at  London 


54  BUREAU  OF  ANIMAL  INDUSTRY. 

that  human  tuberculosis  is  not  transmissible  to  cattle.  Again,  how 
are  we  to  explain  the  human  cultures  of  medium  virulence?  Are  they 
human  bacilli  which,  for  some  unknown  reason,  are  increasing  in  vir- 
ulence and  approaching  the  activity  of  the  bovine  bacillus?  Or  are- 
they  really  bovine  bacilli  which  have  multiplied  in  the  human  body 
until  their  virulence  has  become  attenuated?  In  whatever  manner 
these  questions  are  decided  it  would  seem  that  the  findings  of  the  Ger- 
man commission,  instead  of  supporting  Koch's  views  that  we  can 
decide  with  certainty  by  the  inoculation  of  cattle  as  to  the  source  of 
an}'  given  bacillus,  really  show  that  this  method  of  diagnosis  is 
extremely  uncertain  in  the  present  condition  of  our  knowledge. 

It  is  definitely  admitted  that  4  of  the  human  cultures  caused  general- 
ized tuberculosis  in  cattle;  but  Kossel  suggests  that  it  might  be  possible 
that  the  bacilli  in  cases  of  human  tuberculosis  under  certain  circum- 
stances could  likewise  attain  a  very  high  pathogenic  activity  for 
cattle  without  being  for  that  reason  bovine  bacilli.  Undoubtedly  the 
German  commission  is  confronting  the  two  horns  of  a  dilemma,  either 
one  of  which  is  fatal  to  the  views  of  Koch  as  stated  with  such  positive- 
ness  at  London.  If  we  accept  this  suggestion  thrown  out  by  Kossel, 
we  must  conclude  that  Koch  was  wrong  in  his  claim  that  human 
tuberculosis  can  not  be  transmitted  to  cattle,  and  thus  with  one  blow  we 
destroy  the  entire  experimental  support  which  he  had  for  his  argument 
before  the  British  Congress  on  Tuberculosis.  And  if,  on  the  other 
hand,  we  accept  the  conclusion  which  follows  from  the  principle  laid 
down  by  Koch  for  the  discrimination  between  human  and  bovine 
bacilli,  and  which  appears  to  be  favored  by  Kossel,  we  must  admit 
that  bovine  tuberculosis  is  an  extremely  important  factor  in  the 
etiology  of  human  tuberculosis.  Of  the  39  cases  of  human  tuberculosis 
tested,  4,  or  over  10  per  cent,  were  virulent  for  cattle  and  would  be 
classified  as  of  bovine  origin;  but  these  4  cases  were  all  found  among 
the  16  cases  of  tuberculosis  in  children  which  the  commission  investi- 
gated; hence  it  is  plain  that  25  per  cent  of  the  cases  tested  of  tuber- 
culosis in  children  would  by  Koch's  method  be  classified  as  of  bovine 
origin. 

In  the  Bureau  of  Animal  Industry  two  distinct  lines  of  experiments 
have  been  carried  on,  in  order  that  one  might  serve  as  a  check  against 
the  other.  There  has  been,  however,  no  discrepancy  in  the  results. 
De  Schweinitz,30  in  the  Biochemic  Division,  Bureau  of  Animal  Indus- 
try, has  isolated  9  cultures  from  human  tuberculosis.  Two  of  these 
were  derived  from  human  sputum,  3  from  cases  of  generalized  tuber- 
culosis in  adults,  and  4:  from  cases  of  generalized  tuberculosis  in  chil- 
dren. By  comparing  these  cultures  with  a  newly  isolated  virulent 
culture  of  bovine  tuberculosis,  there  were  found  among  them  2  cultures 
from  children  which  were  identical  in  their  cultural  and  morphological 
characters  with  the  bovine  bacillus.  These  cultures  also  killed  rabbits 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  55 

and  guinea  pigs  in  as  short  a  time  as  did  the  bovine  bacillus.  Hogs 
which  were  inoculated  subcutaneously  with  those  '2  cultures  from  chil- 
dren died  of  generalized  tuberculosis.  Two  calves,  weighing  over 
300  pounds  each,  were  inoculated  subcutaneously  with  these  virulent 
human  cultures,  and  as  a  result  developed  generalized  tuberculosis. 
A  yearling  heifer  inoculated  with  1  of  the  cultures  showed  generalized 
tuberculosis  when  killed  3  months  after  inoculation.  Both  the  cattle 
and  the  hogs  had  been  tested  with  tuberculin  and  found  to  be  free 
from  tuberculosis  before  the  inoculations  were  made.  It  is  important 
to  observe  in  this  connection  that  2  out  of  4,  or  50  per  cent,  of  the 
cultures  obtained  from  cases  of  generalized  tuberculosis  in  children 
proved  virulent  for  cattle. 

Mohler,38  working  in  the  Pathological  Division,  Bureau  of  Animal 
Industry,  has  obtained  3  very  virulent  cultures  of  tubercle  bacilli 
from  the  human  subject.  A  goat  inoculated  subcutaneously  with  1 
of  these  cultures  died  in  37  days  with  miliary  tuberculosis  of  the 
lungs  involving  the  axillary  and  prescapular  glands.  This  bacillus 
was  obtained  from  the  mesenteric  gland  of  a  boy.  Of  still  greater 
interest  is  a  bacillus  isolated  by  Mohler  from  human  sputum.  A 
goat  inoculated  subcutaneously  with  a  culture  of  this  germ  died  in 
95  days  of  pulmonary  tuberculosis.  A  cat  inoculated  in  the  same 
manner  died  in  23  days  of  generalized  tuberculosis.  A  rabbit  simi- 
larly inoculated  died  in  59  days  of  pulmonary  tuberculosis.  Another 
rabbit  inoculated  with  a  bovine  culture  for  comparison  lived  10  days 
longer  than  the  one  inoculated  with  this  sputum  germ.  Mohler  also 
inoculated  subcutaneously  a  1 -year-old  heifer  with  a  culture  derived 
from  the  tubercular  mesenteric  gland  of  a  boy  4  years  of  age.  This 
culture  was  always  refractory  in  its  growth  under  artificial  conditions, 
and  the  bacilli  were  short,  stubby  rods  corresponding  in  appearance 
with  the  bovine  type.  At  the  autopsy,  held  127  days  after  the  inocu- 
lation, the  general  condition  was  seen  to  be  poor  and  unthrifty,  and 
large,  hard  tumors  were  found  at  the  points  of  inoculation.  On  the 
right  side  the  swelling  measured  3£  by  5  inches,  and  the  correspond- 
ing lymph  gland  was  2£  inches  long  by  If  inches  in  diameter.  This 
gland  contained  numerous  calcareous  foci;  one  of  these  at  the  apex 
was  an  inch  in  diameter.  The  lesions  on  the  left  shoulder  of  the 
animal  were  very  similar  to  those  found  on  the  right  side,  but  the 
dimensions  of  the  tumor  were  slightly  less.  The  lungs  presented  an 
irregular  mass  of  tubercular  nodules,  and  7  or  S  grape-like  nodules 
were  seen  on  the  parietal  pleura.  Bronchial  and  niediastinal  lymph 
glands  contained  numerous  tubercular  foci,  and  the  pericardium,  peri- 
toneum, spleen,  and  liver  were  also  affected. 

In  order  to  throw  some  light,  if  possible,  upon  the  morphological 
constancy  of  the  different  types  of  tubercle  bacilli,  Mohler  was 
requested  by  the  chairman  of  your  committee  to  make  comparative 


56  BUREAU  OF  ANIMAL  INDUSTRY. 

studios  of  bacilli  from  various  sources,  and  which  had  been  passed 
through  various  species  of  animals,  by  making1  the  cultures  upon  dog- 
serum  after  the  method  described  by  Theobald  Smith.  Some  impor- 
tant results  have  been  obtained.  One  culture  of  human  bacilli  which 
had  morphological  and  cultural  peculiarities  similar  to  those  of  the 
bovine  bacillus,  and  which  only  produced  local  lesions  in  cattle,  was 
passed  through  a  series  of  5  cats.  It  wras  then  found  to  be  completely 
changed  in  its  morphological  characters,  the  rods  being  elongated, 
slender,  more  or  less  beaded,  and  entirely  of  the  human  type.  But 
far  from  decreasing  in  virulence,  as  might  be  expected  from  its  mor- 
phological appearance,  this  bacillus  had  so  increased  in  its  pathogenic 
activity  that  it  now  produced  generalized  tuberculosis  in  a  cow.  This 
cow  was  inoculated  subcutaneously  in  front  of  each  shoulder  with 
2  c.  c.  of  a  salt  solution  emulsion  of  the  tuberculous  omentum  of  the 
last  cat  of  the  series.  The  cow  rapidty  lost  flesh,  had  a  temperature 
of  lo-i0  F.,  with  the  point  of  inoculation  and  adjacent  glands  greatly 
swollen.  The  autopsy  revealed  generalized  tuberculosis,  involving 
the  lungs,  mediastinal  glands,  spleen,  liver,  and  kidneys.  Tubercle 
bacilli  of  the  bovine  type  obtained  from  the  mesenteric  glands  of  a 
sheep,  hog,  and  cow  were  similarly  transformed  in  their  morpholog- 
ical appearance  after  being  passed  through  a  series  of  cats  and  recov- 
ered on  dog  serum.  These  bacilli  also  increased  in  virulence,  as  the 
last  cat  in  the  series  invariabty  succumbed  in  a  shorter  time  than  the 
first  of  the  series. 

These  experiments  and  observations  indicate  that  the  types  of 
tubercle  bacilli  are  very  inconstant,  and  that  under  suitable  conditions 
they  readily  change  both  in  morpholog}'  and  in  virulence.  A  similar 
conclusion  was  reached  by  other  investigators  in  working  with  the 
avian  and  piscine  types  of  tubercle  bacilli  several  years  ago,  and  was 
reasonably  to  have  been  expected  with  the  human  and  bovine  types. 

It  must  be  plain  to  all,  from  these  recent  developments,  that  too 
much  has  been  made  of  the  slight  differences  in  cultural  characteristics, 
in  morphology,  and  in  virulence  which  have  been  observed  in  some 
cases  in  comparing  the  human  and  the  bovine  bacilli.  The  observa- 
tions were  interesting,  and  it  was  important  that  they  should  be  fol- 
lowed up  until  their  significance  was  made  entirely  clear;  but  it  was 
an  almost  unpardonable  error,  from  a  sanitary  point  of  view,  to  pro- 
mulgate sweeping  generalizations  calculated  to  arrest  and  abolish 
important  measures  for  preventing  human  tuberculosis  before  the 
soundness  of  these  generalizations  had  been  established  by  a  thorough 
course  of  experimentation. 

When  Koch  said  in  the  British  Congress  on  Tuberculosis  that  he 
should  estimate  the  extent  of  infection  by  the  milk  and  flesh  of  tuber- 
cular cattle  and  the  butter  made  of  their  milk  as  hardly  greater  than 
that  of  hereditary  transmission,  and  that  he  therefore  did  not  deem  it 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  57 

advisable  to  take  any  measures  against  it,  he  went  far  beyond  what 
was  justified  by  any  experiments  or  observations  which  he  reported, 
and  he  did  an  immense  amount  of  harm  which  will  be  manifested  for 
years  to  come  to  those  who  endeavor  to  guard  the  human  race  from 
the  dangers  of  animal  tuberculosis.  The  researches  to  which  your 
committee  has  alluded  make  these  dangers  more  definite  and  certain 
than  they  have  appeared  before,  and  sanitarians  should  therefore  most 
earnestly  endeavor  to  counteract  the  erroneous  and  harmful  impres- 
sion which  was  made  by  Koch's  address  at  London  and  his  subsequent 
address  at  the  International  Conference  on  Tuberculosis  at  Berlin. 

Now  that  the  conclusions  of  the  London  address  are  shown  to  be 
incorrect  and  based  on  insufficient  experimentation,  it  is  well  that  some 
attention  should  be  given  to  the  Berlin  address,  in  which  certain  rules 
were  laid  down  for  testing  all  clinical  evidence  before  it  can  be  accepted 
as  indicating  the  transmission  of  tuberculosis  from  animals  to  man. 
While  your  committee  agrees  that  it  is  advisable  to  scrutinize  clinical 
evidence  as  carefully  as  possible  before  it  is  accepted  as  influencing 
the  decision  of  such  an  important  question,  consistency  demands  that 
we  should  accept  clinical  evidence  bearing  upon  the  transmission  of 
bovine  tuberciilosis  to  man  on  the  same  terms  that  we  accept  evidence 
bearing  upon  the  transmission  of  tuberculosis  from  man  to  man.  For 
instance,  Koch  said  in  his  London  address,  "So  the  only  main  source 
of  the  infection  of  tuberculosis  is  the  sputum  of  consumptive  patients." 
How  does  he  know  this?  Has  he  any  evidence  to  support  this  con- 
clusion which  will  stand  the  requirements  which  he  has  laid  down  for 
those  who  oppose  his  views  with  reference  to  the  transmission  of  ani- 
mal tuberculosis  to  man  \  If  so,  this  evidence  has  not  yet  been  pre- 
sented. Your  committee  believes  that  the  principal  source  of  tuber- 
culosis in  man  is  infection  from  other  tuberculous  human  subjects,  but 
it  also  believes  that  a  considerable  proportion  of  the  cases  of  tubercu- 
losis in  man  is  due  to  infection  from  animal  sources;  and  in  weighing 
the  evidence  by  which  we  are  to  fix  more  rigorously  the  relation 
which  these  two  sources  of  infection  bear  to  each  other  it  is  logical 
that  we  should  apply  the  same  rules  of  evidence  in  each  case. 

The  rules  which  Koch  formulated  for  testing  the  evidence  as  to 
bovine  infection  are  given  below,  with  such  brief  comments  as  your 
committee  feels  they  deserve: 

(1)  Certain  proof  of  tubercle,  and  where  possible  the  primary  focus 
must  be  supplied. 

To  this  condition  no  objection  is  raised,  but  it  should  be  remarked 
that  the  location  of  the  primary  focus,  which  is  made  so  much  of,  is  of 
little  value  in  determining  the  origin  of  the  infection.  It  has  been 
clearly  shown  by  various  investigators,  whose  work  has  been  referred 
to  in  the  preceding  reports  of  this  committee,  that  tubercle  bacilli  may 
pass  through  the  walls  of  the  intestine  without  producing  any  lesion 
at  the  point  of  entrance,  and  that  their  first  point  of  lodgment  and 


58  HUREAU  OF  ANIMAL  INDUSTRY. 

multiplication  ma}*  bo  the  mesenteric  glands,  the  liver,  spleen,  or  even 
the  lungs.  On  the  other  hand,  Koch  has  told  us  that  the  location  of 
the  primary  lesion  in  the  intestine  is  of  no  significance,  because  human 
as  well  as  animal  bacilli  may  be  swallowed  and  may  be  the  cause  of 
such  lesions.  It  is  therefore  not  at  all  apparent  that  this  is  an  essential 
point. 

(~2)  Other  sources  of  infection  must  be  excluded  with  -certaint}*. 

This  condition  appears  to  exclude  all  clinical  evidence  bearing  upon 
the  source  of  tubercular  infection.  How  is  it  possible  to  prove  that  any 
given  individual  has"  not  been  exposed  to  the  bacilli  of  human  tuber- 
culosis ?  And.  for  the  same  reason,  how  is  it  possible  to  prove  that 
any  given  individual  has  not  been  exposed  to  the  bacilli  of  animal 
tuberculosis  '(  It  may  be  said  that  this  consumptive  person  had  habitu- 
ally been  in  a  room  with  another  consumptive  patient  and  was  infected 
from  that  patient;  but  how  can  you  prove  that  this  person  never  ate 
any  tuberculous  meat,  never  partook  of  any  tuberculous  milk,  never 
ate  any  butter  containing  the  tubercle  bacillus,  never  had  an  opportu- 
nity to  be  indirectly  infected  from  the  hands  of  cooks  or  from  table 
utensils  which  had  been  in  contact  with  tuberculous  meat,  milk,  or 
butter,  and  was  never  exposed  to  the  infection  scattered  in  so  many 
ways  by  tuberculous  animals?  It  is  impossible  to  exclude  with 
certainty  all  these  sources  of  infection,  and  if  we  apply  the  condition 
under  discussion  to  the  evidence  upon  which  Koch  based  the  assertion 
that  the  main  source  of  the  infection  of  man  is  the  sputum  of  con- 
sumptive patients  we  should  find  no  part  of  it  that  would  stand  the 
test.  Now,  is  it  logical  to  accept  clinical  evidence  as  to  the  transmis- 
sion of  tuberculosis  from  man  to  man  by  one  set  of  rules  and  to  require 
an  entirely  different  set  of  rules  when  considering  evidence  as  to  the 
transmission  of  the  same  disease  from  animals  to  man '(  Your  com- 
mittee is  of  the  opinion  that  clinical  evidence  should  be  regarded  as 
valuable  in  confirming  experimental  researches,  or  in  indicating  the 
probable  facts  where  experimentation  has  been  insufficient  or  is  impos- 
sible, but  that  it  is  too  much  to  expect  that  clinical  evidence  will  be 
forthcoming  as  to  the  transmission  of  tuberculosis  which  will  exclude 
all  possible  sources  of  error. 

(3)  In  each  case  of  alleged  infection  from  milk  affected  with  bovine 
tuberculosis  the  condition  of  the  rest  of  the  people  who  have  taken 
the  same  milk  should  be  borne  in  mind.  These  fellow-consumers  form 
to  a  certain  extent  a  control  experiment,  and  if  of  the  numerous  peo- 
ple who  have  drunk  the  suspected  milk  only  a  single  one  sickens,  this 
weighs  decidedly  against  the  belief  that  this  one  person  was  infected 
by  the  common  food. 

This  condition  also  is  regarded  by  }Tour  committee  as  illogical  and 
impossible  of  general  application  without  discarding  all  clinical  evi- 
dence upon  this  question.  If  we  apply  it  to  the  alleged  cases  of 


BOVINE    TUBERCULOSIS    AND   PUBLIC    HEALTH.  59 

sputum  infection,  we  tind  it  is  seldom,  indeed,  that  the  disease  in  more 
than  one  person  can  be  traced  with  any  probability  to  the  same  tuber- 
culous patient,  although  scores  of  persons  may  have  been  exposed  to 
that  patient.  Most  people  who  escape  tuberculosis  have  nevertheless 
been  exposed  main'  times  to  tuberculous  patients,  but  this  is  not  suffi- 
cient reason  for  concluding-  that  others  have  not  contracted  the  disease 
by  similar  exposure.  Tuberculosis  is  a  disease  which  is  communicated 
with  such  difficulty  among  people  under  ordinary  conditions  of  life, 
by  exposure  either  to  diseased  persons  or  to  tuberculous  food,  develops 
so  slowh',  and  varies  so  much  in  the  period  which  elapses  before 
symptoms  are  observed,  that  it  is  only  very  rarely  that  groups  of 
cases  are  observed  which  even  appear  to  have  originated  from  the 
same  source.  And  yet  how  erroneous  it  would  be  to  exclude  clinical 
evidence  suggesting  contagion  because  only  one  of  those  exposed  to  a 
certain  consumptive  patient  had  contracted  the  malady. 

(4)  The  source  of  the  milk  should  be  attended  to.  Since  in  recent 
years  it  has  become  more  and  more  evident  that  milk  containing 
tubercle  bacilli  is  yielded  only  by  such  cows  as  suffer  from  tubercu- 
losis of  the  udders,  the  general  statement  that  someone  has  drunk  milk 
from  a  cow  suffering  from  tuberculosis  no  longer  suffices  to  prove  to 
us  that  bovine  tuberculosis  bacilli  have  really  reached  his  digestive 
organs.  It  must  be  from  a  cow  with  tuberculosis  of  the  udder,  and 
therefore  a  statement  on  this  subject  should  not  be  wanting  in  a  report 
on  milk  infection  if  it  is  said  to  be  complete. 

Your  committee  rinds  this  statement  of  fact  to  be  incorrect,  since 
the  tendency  of  recent  investigations  by  competent  persons  is  to  make 
it  more  and  more  evident  that  cows  with  tuberculosis  may  yield  milk 
containing  tubercle  bacilli  when  the  udders  present  no  signs  of  the 
disease.  The  argument  is  therefore  antiquated.  Of  the  many 
experiments  that  have  been  made  to  determine  the  proportion  of 
tuberculous  cows  which  yield  infectious  milk,  the  average  results  are 
about  15  per  cent,  while  the  cases  of  tuberculosis  of  the  udder  are 
about  2  per  cent.  In  recent  investigations  made  by  Mohler,  of  the 
Bureau  of  Animal  Industry,  with  oti  reacting  cows,  it  was  found  that 
1*2  of  these,  or  21.4  per  cent,  at  one  time  or  another  during  the  experi- 
ment gave  milk  which  contained  virulent  tubercle  bacilli.  Undoubt- 
edly cows  with  tuberculosis  of  the  udder  yield  milk  containing  a  larger 
number  of  tuberculosis  bacilli  than  do  those  in  which  the  udder  remains 
unaffected,  and  are  therefore  more  dangerous,  but  it  has  been  dearly 
shown  that  other  tuberculous  cows  may  yield  virulent  milk. 

So  much  for  the  conditions  laid  down  bj-  Koch  for  testing  clinical 
evidence  bearing  upon  the  transmission  of  tuberculosis  from  animals 
to  man.  The  effort  to  rule  out  all  such  evidence  by  applying  impos- 
sible tests  does  not  meet  with  our  approval,  but  fortunately  clinical 


60  BUREAU    OF    ANIMAL    INDUSTRY. 

evidence  is  no  longer  necessary  for  deciding  the  question.  The  sub- 
cutaneous injection  of  cattle  with  pure  cultures  of  the  tuberculosis 
bacillus  from  human  sources,  which,  according  to  Koch,  "yields  quite 
specially  characteristic  and  convincing  results,"  has  proved,  in  the 
hands  of  the  German  commission  no  less  than  in  those  of  independent 
investigators,  that  bovine  tuberculosis  is  communicable  to  man.  It 
will  require  much  work  to  decide  with  even  approximate  accuracy  the 
proportion  of  human  tuberculosis  caused  by  animal  infection;  but  the 
fact  that  25  per  cent  of  the  cases  in  children  investigated  by  the 
German  commission,  and  50  per  cent  of  similar  cases  investigated  by 
de  Schweinitz,  showed  by  this  test  that  they  were  caused  by  animal  infec- 
tion is  sufficient  to  convince  us  that  measures  should  be  taken  and 
enforced  at  once  to  guard  against  infection  from  this  source. 

in  concluding,  your  committee  desires  to  express  its  appreciation  of 
the  prompt,  intelligent,  and  indefatigable  work  of  those  scientific 
investigators  who  took  up  this  question  immediately  after  it  was  brought 
to  the  front  at  London,  and  in  the  comparatively  short  period  of  about 
two  years  have  furnished  the  material  for  definitely  settling  it,  so  far 
as  the  principal  contention  is  concerned. 


BIBLIOGRAPHY. 

(1)  Bull.  No.  84,  Wisconsin  Agric.  Exper.  Station,  March,  1901. 

(2)  KOCH,  ROBERT. 

Address  on  the  combating  of  tuberculosis  in  the  light  of  experience  gained 
in  the  combating  of  other  infectious  diseases.  Trans.  Brit.  Cong,  on  Tubercu- 
losis for  Prevention  of  Consumption,  London,  July  22-26,  1901,  v.  1,  pp.  23-35. 
1902. 

(3)  CHAUVEAU,  A. 

L'identitede  la  tuberculose  de  1'homme  et  dela  tuberculose  du  boeuf,  d'apres 
les  resultats  des  experiences  sur  1'infection  des  sujets  de  1'espece  bovine  par  les 
matieres  tuberculoses  empruntees  a  1'espece  humaine.  Cong.  p.  1'etude  de  la 
tuberculose,  Paris,  2«  session,  1891,  pp.  51-63.  1892. 

(4)  RAVENEL,  MAZYCK  P. 

Three  cases  of  tuberculosis  of  the  skin  due  to  inoculation  with  bovine  tubercle 
bacillus.  Phila.  Med.  Journ.,  July  21,  1900. 

(5)  PFEIFFER,  L. 

Ztschr.  f.  Hyg.,  Bd.  3,  p.  209.     1888. 

(6)  Omaha  Clinic,  Feb.,  1896. 

(7).  Cited  by  Theobald  Smith  in  Journ.  Exper.  Med.,  v.  3,  p.  505,  from  Rev.  gen. 
d'opthalm.,  v.  15,  p.  433.     1896. 

(8)  Inauguration  dissertation.     Ztschr.  f.  Med. -Beamte,  No.  11.     1896'. 

(9)  Proc.  Cong,  for  Study  of  Human  and  Animal  Tuberculosis,  1st  sess.,  Paris, 

p.  275.     1888. 

(10)  OSTERTAG,  ROBERT. 

Handbuch  d.  Fleischbeschau,  p.  638.     1899. 

(11)  Dublin  Journ.  Med.  Sci.,  n.  ser.,  v.  103,  pp.  378-386.     1897.     Also  cited  by 

Nocard,  Les  tuberculoses  animales,  p.  124. 


BOVINE    TUBERCULOSIS    AND   PUBLIC   HEALTH.  61 

(12)  Cited  by  Law,  from  Eep.  Vet,  Cong.  Brussels,  p.  288.     1883.     Also  cited  by 

Nocard,  from  Compt.  rend.  4th  Internat.  Vet.  Cong.,  Brussels,  p.  188.     1883. 

(13)  LAW,  JAMES. 

Papers  and  addresses,  New  York  State  Vet.  College,  1896-98,  p.  85. 

(14)  LAW,  JAMES. 

Papers  and  addresses,  New  York  State  Vet.  College,  1896-98,  p.  86.     From 
•Tuberculosis,  National  Vet.  Assoc.,  London,  1883. 

(15)  NOCARD,  ED. 

Les  tuberculoses  animales,  p.  123. 

(16)  Journ.  Tuberculosis,  April,  1899,  p.  64. 

(17)  Brit.  Med.  Journ.,  Aug.  19,  1899,  p.  455. 

(18)  Brit.  Med.  Journ.,  Sept.  2,  1899,  p.  626. 

(19)  Edinburgh  Hospital  Rep.,  1900.     Cited  by  Still  in  The  Practitioner,  July,  1901. 

(20)  The  Practitioner,  July,  1901. 

(21)  Quoted  by  Still,  from  Trans.  Med.  Sot-.  London,  p.  292.     1894. 

(22)  Quoted  by  Still,  from  The  Lancet,  v.  1,  p.  286.     1899. 

(23)  Edinburgh  Hospital  Rep.,  1900.     New  York  Med.  Journ.,  Feb.  21,  1891.    Cited 
by  Still  in  The  Practitioner,  July,  1901. 

(24)  New  York  Med.  Journ.,  Feb.  21,  1891.     Tul>erctilosis  in  children. 

(25)  Lancet,  London,  v.  2,  pp.  957-960.     1894. 

(26)  Lancet,  London,  Sept.  17,  p.  733.     1898. 

(27)  Journ.  Amer.  Med.  Assoc.,  Aug.  31,  p.  590.     1901. 

(28)  Phila.  Med.  Journ.,  Aug.  24,  p.  284.     1901. 

(29)  LARTIGAU,  AUGUST  JKROME. 

A  study  of  the  variation  in  virulence  of  the  bacillus  tuberculosis  in  man. 
Journ.  of  Med.  Research,  Boston,  No.  62,  v.  6,  No.  1  (n.  ser.,  v.  1,  No.  1), 
July,  pp.  156-162.  1901. 

(30)  DE  SCHWEINITZ,  E.  A.,  and  M.  DORSET. 

Experiments  in  the  virulence  of  tuberculosis  bacilli.  Bull.  No.  52,  Bureau 
of  Animal  Industry.  (In  press. ) 

(31)  KOCH,  ROBERT. 

Die  Aetiologie  der  Tuberculose.  Berlin,  klin.  Wclmschr.,  19.  Jhrg.,  No.  15, 
10.  Apr.,  pp.  221-230.  1882. 

(32)  REPORT  OK  COMMITTEE  ON  ANIMAL  DISEASES  AND  ANIMAL  FOOD. 

Reports  and  papers,  Amer.  Pub.  Health  Assoc.,  Buffalo,  Sept.  16-20,  1901, 
v.  27,  pp.  45-77.  Columbus,  Ohio.  1902.  (Also  included  in  the  present 
bulletin.) 

(33)  BOLLINGER,   (). 

Ueber  die  Identitiit  der  Perlsucht  der  Kinder  mit  der  menschlichen  Tuber- 
culose. Mum-hen,  med.  Wchnschr.,  41.  Jhrg.,  No.  5,  30.  Jan.,  pp.  85-86,  1  fig. 
1894. 

(34)  MARTIN,  SIDNEY. 

Influence  upon  animals  of  food  of  tuberculous  origin:  Influence  upon  man. 
Rej>ort  of  royal  commission  appointed  to  inquire  into  the  effect  of  food  derived 
from  tul>erculoiis  animals  on  human  health.  Pt.  1,  pp.  9-17.  London.  1895. 

(35)  VAGEDES. 

Experimentelle  Prufung  der  Virulenz  von  Tuberkelbacillen.  Zt.schr.  f.  Hyg. 
u.  Infeetionskninkh.,  I^eipzig,  Bd.  28,  Heft  2,  pp.  276-320,  figs.  1-tf.  19.  A  tig,, 
1898. 

(36)  SMITH,  THEOBALD. 

The  relation  l>etween  Ixwiiu*  and  human  tul>erculosis.  Med.  News,  N.  Y., 
V.  80,  No.  8,  Feb.  22,  pp.  343-346.  1902. 


62  BUREAU    OF    ANIMAL    INDUSTRY. 

(37)  RAVEXEL,  MAZYCK  P. 

The  intercommunicability  of  human  and  bovine  tuberculosis.  Medicine, 
Detroit,  v.  8,  Xo.  7,  July,  pp.  529-546,  figs.  1-5;  No.  8,  Aug.,  pp.  617-632,  figs. 
6-9.  1902. 

(38)  (Report  not  yet  published.) 

(39)  TlIOMASSKX. 

The  receptivity  of  bovine  animals  for  the  bacillus  of  human  tuberculosis. 
Trans.  Brit.  Cong,  on  Tuberculosis  for  Prevention  of  Consumption,  London, 
July  22-26,  1901,  v.  4,  pp.  21-27.  1902. 

(40)  DE  JONG,  A. 

Experiences  comparatives  sur  Faction  pathogene  pour  les  animaux,  notam- 
inent  pour  ceux  de  1'espece  bovine,  des  bacilles  tuberculeux  provenantdu  bu-uf 
et  de  1'homme.  Ann.  de  med.  vet.,  Bruxelles,  v.  51,  Xo.  4,  avril,  pp.  181-190; 
Xo.  5,  mai,  pp.  251-259.  1902. 

(41)  DELEPIXE,  SHERIDAX. 

A  discussion  on  the  relationship  of  human  and  bovine  tuberculosis.  Brit. 
Med.  Journ.,  London,  Xo.  2178,  Sept.  27,  p.  947.  1902. 

(42)  ORTII,  J. 

Ueber  einige  Zeit-  und  Streitfragen  aus  dem  Gebiete  der  Tuberculose.  II. — 
Was  1st  Perlsucht?  Berlin,  klin.  Wchnschr. ,  39.  Jhrg.,  Xo.  34,  25.  Aug.,  pp. 
793-798.  1902. 

(43)  STEXSTROM,  OLOF. 

Die  Tuberculose  des  Menschen  und  der  Kinder.  Ztschr.  f.  Thiermed.,  Jena, 
n.  F.,  Bd.  6,  Heft  4,  pp.  289-291.  1902. 

(44)  FIBIGER,  JOHAXXES,  and  C.  O.  JEXSEX. 

Uebertragung  der  Tuberculose  des  Menschen  auf  das  Rind.  Berlin,  klin. 
Wchnschr.,  39.  Jhrg.,  Xo.  38,  22.  Sept.,  pp.  881-886.  1902. 

(45)  WOLFF,  MAX. 

Perlsucht  und  menschlichen  Tuberkulose.  Deutsche  med.  \Vchnschr.,  Leip- 
zig, 28.  Jhrg.,  Xo.  32,  7.  Aug.,  pp.  566^570.  1902. 

(46)  XOCARD,  ED. 

Experiences  sur  la  tuberculose.  Rev.  vet.,  Toulouse,  An.  27  (59),  Xo.  1, 
ler  Jan.,  pp.  49-54.  1902. 

(47)  ARLOIXG,  S. 

L'inoculabilite  de  la  tuberculose  humaine  et  les  idees  de  M.  Robert  Koch 
sur  cette  tuberculose  et  la  tuberculose  animale.  Bull.  A  cad.  de  med.,  Paris, 
v.  65,  3.  ser.,  v.  46,  Xo.  43,  24  dec.,  pp.  897-911.  30  dec.,  1901. 

(48)  BEHRIXG,  E.  v.,  P.  HOMER,  and  W.  G.  RITPEL. 

Tuberkulose.     xviii,  90  pp.     Marburg.     1902.     (In  Beitriige  7Air  experimen- 
tellen  Therapie,  Heft  5,  Theil  1,  Text  und  Anlage.) 
(49\  DEAN,  GEORGE,  and  CHARLES  Tor>n. 

Abstract  of  certain  experiments  on  tuberculosis.  The  Lancet,  London,  No. 
4131,  v.  163,  Xo.  18  (v.  2,  1902),  Nov.  1,  pp.  1186-1187.  1902. 

(50)  RAVEXEL,  MAZYCK  P. 

Discussion  on  tubercle  bacilli  in  cows'  milk  as  a  possible  source  of  tubercu- 
lous disease  in  man.  Trans.  Brit.  Cong,  on  Tuberculosis  for  Prevention  of 
Consumption,  London,  July  22-26,  1901,  v.  1,  pp.  91-92.  1902. 

(51)  SPROXCK,  C.  H.  H.,  and  K.  HOEFXAGEL. 

Transmission  a  Fhonime,  par  inoculation  accidentelle,  de  la  tuberculose 
bovine,  et  reinoculatioii  experimentale  au  veau.  La  Semaine  med.,  Paris,  An. 
22,  Xo.  42,  15  oct.,  pp.  341-343,  figs.  1-4.  1902. 


BOVINE    TUBERCULOSIS    AND    PUBLIC    HEALTH.  63 

(52)  LASSAR,  O. 

Ueber  Impftuberkulose.  Deutsche  med.  Wehnschr.,  Leipzig,  28.  Jhrg., 
No.  40,  2.  Oct.,  pp.  716-718.  1902. 

(53)  HULS. 

Zur  Frage  der  Uebertragung  der  Rindertuberkulose  auf  den  Menschen. 
Miinchen.  med.  Wchnschr.,  49.  Jhrg.,  No.  24,  17.  Juni,  pp.  1003-1004.  1902. 

(54)  HELLER,  ARNOLD. 

Kleine  Beitriige  zur  Tuberkulose-Frage.  Miinchen.  med.  Wchnschr.,  49. 
Jhrg.,  No.  15,  15.  Apr.,  pp.  609-611.  1902. 

(55)  GOTTSTEIN,  A. 

Statistische  Beitriige  zur  Verbreitung  der  Tuberkulose.  Miinchen.  med. 
Wchnschr.,  Bd.  48,  No.  41,  8.  Okt.,  pp.  1610-1612,  tables  l-4b.  1901. 

(56)  DOBROKLOXSKI,  V. 

De  la  penetration  des  bacilles  tuberculeux  dans  1'organisme  a  travers  la 
muqueuse  intestinale  et  du  developpement  de  la  tuberculose  experimentale. 
Arch,  de  med.  exper.  et  d'anat.  path.,  Paris,  1.  ser.,  v.  2,  pp.  253-271.  1890. 

(57)  DESOUBRY,  G.,  and  CH.  PORCIIER. 

De  la  presence  de  microbes  dans  le  chyle  normal  chez  le  chien.  Compt. 
rend.  Soc.  de  biol.,  Paris,  v.  47,  10.  ser.,  v.  2,  No.  5,  15  fev.,  pp.  101-104.  1895. 

(58)  NICOLAS,  J.,  and  A.  DESCOS. 

Passage  des  bacilles  tuberculeux  apres  ingestion  dans  les  chyliferes  et  le 
canal  thoracique.  Journ.  de  physiol.  et  de  path,  gen.,  Paris,  v.  4,  No.  5, 15  sept., 
pp.  910-912.  1902. 

(59)  KOCH,  ROBERT. 

Menschen-  und  Thiertuberkulose.  Bericht  erste  Internat.  Tuberk.-Konf., 
Berlin,  22. -26.  Oct.,  1902,  pp.  348-361.  1903. 

Translation.  In  Brit.  Med.  Journ.,  London,  No.  2190,  v.  2,  Dec.  20,  pp.  1885- 
1889.  1902. 

(60)  SMITH,  THEOBALD. 

A  comparative  study  of  bovine  tubercle  bacilli  and  of  human  bacilli  from 
sputum.  Journ.  Exper.  Med.,  v.  3,  p.  506.  1898. 

(61)  KOSSEL,  H. 

Mittheilungen  iiber  Versuche  an  Rindern  mit  Tuberkelbacillen  verschie- 
dener  Herkunft.  Berlin,  klin.  Wchnschr.,  40.  J.,  No.  29,  20.  Juli,  pp.  653-657. 
1903. 


(Continued  from  second  page  of  cover.) 


Dr.  C.  L.  Morin,  St.  Alhnns,  Vt. 

Dr.  A.  B.  Morse,  care  The  Agar  Packing  Co.,  Des 

Moines,  Iowa. 
Dr.  \V.  J.  Murphy,  care  Springfield  I'r 

Bright  wood,  Mass. 
Dr.   W.   N.   Neil,   cure    John  Cudahy  Company. 

Wichita,  Kans. 
Dr.  H.  D.  Paxson,  care  Swift  &  Co.,  Fort  Worth. 

Tex. 

Dr.  F.  M.  Perry.  Fort  Fairfield,  Me. 
Dr.    (r.    W.   Pope,   Animal    Quarantine   Station, 

Athenia.  N.  J. 
Dr.  H.  T.  Potter,  Calais,  Me. 
Dr.  A.  G.  G.  Richardson,   Room  16,   Deaderick 

Building.  Knoxville,  Tenn. 
Dr.  W.  H.  Rose,  18  Broad  way,  New  York,  N.  Y. 
Dr.  F.  L.  Russell,  Orono,  Me. 
Dr.  J.  F.  Ryder,  care  U.  S.  consul,  Liverpool,  Eng- 
land. 
Dr.  E.  P.  Schaffter,  care  Cleveland  Provision  Co., 

Cleveland,  Ohio. 


Dr.  C.  A.  Schaufler,  131  South  Second  st.,  Phila- 
delphia. Pa. 

Dr.  T.  A.  Shipley,  care  T.  M.  Sinclair  &  Co.,  Ltd., 
Cedar  Rapids,  Iowa. 

Dr.  N.  C.  Sorensen,  care  Kingan  &  Co.,  Indian- 
apolis, Ind. 

Dr.  R.  P.  Steddom,  147  Milk  St.,  Boston,  M 

Dr.  N.  L.  Townsend,  Fremont,  Nebr. 

Dr.  Win.  H.  Wade,  Animal  Quarantine  Station, 
Halethorp,  Md. 

Dr.H.  X.  Waller.  10'J  Wrst  42d  8t,  New  York.  N.  Y. 

Dr.  G.  W.  Ward,  Newport,  Vt. 

Dr.  B.  P.  Wende,  Live  Stock  Kxchange  Building, 
East  Buffalo,  N.  Y. 

Dr.  W.  H.  Wray,  39  Hawarden  Grove,  Herne  Hill, 
London,  S.  E.,  England. 

Dr.  C.  H.  Ziuk,  care  Western  Packing  Co.,  Denver, 
Colo. 


